{"id":22742,"date":"2020-12-16T10:44:19","date_gmt":"2020-12-16T10:44:19","guid":{"rendered":"http:\/\/onlineclassesguru.com\/?p=22742"},"modified":"2020-12-16T10:44:19","modified_gmt":"2020-12-16T10:44:19","slug":"what-are-the-expected-rates-of-reimbursement-for-this-time-frame-for-each-payercalculating-individual-reimbursement-rates-for-the-5-payers-commercial-medicare-medicaid-liability-self-pay-other","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2020\/12\/16\/what-are-the-expected-rates-of-reimbursement-for-this-time-frame-for-each-payercalculating-individual-reimbursement-rates-for-the-5-payers-commercial-medicare-medicaid-liability-self-pay-other\/","title":{"rendered":"What are the expected rates of reimbursement for this time frame for each payer?Calculating Individual Reimbursement Rates for the 5 Payers (Commercial Medicare Medicaid Liability Self pay \/ Other"},"content":{"rendered":"<style type=\"text\/css\"><\/style><h4>What are the expected rates of reimbursement for this time frame for each payer?Calculating Individual Reimbursement Rates for the 5 Payers (Commercial Medicare Medicaid Liability Self pay \/ Other<\/h4>\n<p>Healthcare Finance: HLTH420 \u2013 1304A 01<br \/>\nUnit3 \u2013 Individual Project<br \/>\n500-700 words<br \/>\nYour facility has the following payer mix:<\/p>\n<p>40% commercial insurances = 800<br \/>\n25% Medicare insurance = 500<br \/>\n15% Medicaid insurance = 300<br \/>\n15% liability insurance = 300<br \/>\n5% all others including self-pay = 100<\/p>\n<p>Assume that for the time in question you have 2000 cases in the proportions above. (what are the proportions of the total cases for each payer?)<br \/>\n(Calculated above )<br \/>\nThe average Medicare rate for each case is $6200- use this as the baseline. Commercial insurances average 110% of Medicare, Medicaid averages 65% of Medicare, Liability insurers average 200% of Medicare and the others average 100% of Medicare rates. (what are the individual reimbursement rates for all 5 payers?)<\/p>\n<p>Calculating Individual Reimbursement Rates for the 5 Payers (Commercial Medicare Medicaid Liability Self pay \/ Other<br \/>\nMedicare Rate (Baseline) $6200<br \/>\nCommercial Insurance 110%<br \/>\nMedicaid 65% of Medicare<br \/>\nLiability Insurers 200% of Medicare<br \/>\nOthers Average 100% of Medicare Rates<br \/>\n1. What are the expected rates of reimbursement for this time frame for each payer? What is your expected A\/R?<br \/>\n2. What rate should you charge for these services (assuming one charge rate for all payers)?(this gives you your total A\/R.) Calculate the total charges for all cases based on this rate.<br \/>\n3. What is the difference between the two A\/R rates above? Can you collect it from the patient? What happens to the difference?<br \/>\nRate to be charged for Services $12,400 *125% Total= $15,500 2000 *$15,500= 31,00,000.00You may not collect over R\/C contracted fees if you are a Participating Provider. However you would be able to collect on a self-pay patient.Differences would need to be a write-off. Cost Fixed Variable Direct IndirectMaterials\/Supplies Variable Direct Wages Fixed Direct Utility\/Building Variable Indirect Medications Variable Direct Licensing of Facility Fixed Indirect Insurances Fixed Indirect PerDiem Staff Variable Direct Materials\/Supplies $ 2,270.00 Wages $ 2,000.00 Utility\/Building 1,125.00 Insurances $ 175.00 TFC\/TVC $2,175.00 $3,395.00 Contribution Margin $14,105,XXX-XX-XXXX000 $5,565,000.00 CM per case (NNN) NNN-NNNN2000 $2,782.50 BREAK EVEN $2600000\/$2782.5 934.41 $150,000 PROFIT 150,000=2782.50V -(NNN) NNN-NNNN P=(V x AR) \u2013 TFC V= (NNN) NNN-NNNN The only payers possible to use for an NIC<br \/>\n4. Which of these costs are fixed (does not change z)? Which are variable(changes)? Direct or indirect? Your costs can be either direct or indirect, which is a description of how they are associated with production. (Direct costs are associated with specific units while indirect costs are a lump sum that goes into doing business in general and cannot be easily measured with the production of a specific thing).<br \/>\no materials\/supplies (gowns, drapes, bedsheets) variable indirect<br \/>\no Wages (nurses, technicians) fixed indirect<\/p>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>What are the expected rates of reimbursement for this time frame for each payer?Calculating Individual Reimbursement Rates for the 5 Payers (Commercial Medicare Medicaid Liability Self pay \/ Other Healthcare Finance: HLTH420 \u2013 1304A 01 Unit3 \u2013 Individual Project 500-700 words Your facility has the following payer mix: 40% commercial insurances = 800 25% Medicare&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-22742","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - 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