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Problem 1

OVERVIEW:

John Rossi, MD is an Internal Medicine Physician. For the year 2016 he had the following Payor Mix:

Insurance Patient Type Contract Type Contract Rate Per Visit* or PMPM** Patients Monthly Utilization Visits
HMO A Commercial Fee for Service $ 85.00 1,100 10% 1,320
HMOB Medicare Capitation $ 45.00 500 31% 1,860
HMOB Medicaid Capitation $ 15.00 350 9% 378
Medicare Medicare Fee for Service $ 65.00 400 34% 1,632
Medicaid Medicaid Fee for Service $ 35.00 435 11% 574
None Self Pay Fee for Service $ 85.00 320 8% 307

Total 3,105 6,071

* Average rate per visit
** Per member per month

REQUIRED:

A. Using an Excel Worksheet, calculate Dr. Rossi’s revenues for 2016.

B. HMO A has offered Dr. Rossi $11 PMPM capitation rate. Should he accept this offer? Why or why not?

Problem 2

OVERVIEW:

The Orthopedic Unit at Collins General Hospital had the following cases, excluding outliers:

 

REQUIRED:

A. What is the average Per Diem paid by Medicare and the actual average Per Diem the hospital realized?

B. State at least two reasons why the actual ALOS was higher than the average MS-DRG LOS?

Rubrics:
Submission of both problems 50%
Problem 1A 10%
Problem 1B 15%
Problem 2A 10%
Problem 2B 15%

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