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HOPPS/ASC: Use the information found in figures 1–5 below to completethe OPPS payment calculations in table 1 and the ASC PPS payment calculationsin table 2. Determine the OPPS and ASC reimbursement rates for acataract procedure. Answer the discussionquestion.Click and download the exercise and the answer sheet.  Submit answer sheet via blacboard by or before 11/9/2015Figure 1: HospitalInformationBedsize:Teachingstatus:Wage index:.9971300 bedsNon-teachingCost to Charge Ratios(CCRs)RC250Pharmacy,general0.408344RC270Supplies,general0.796788RC271Nonsterilesupply0.796788RC272Sterilesupply0.796788RC276Intraocularlens0.796788RC301Chemistry0.291546RC312Pathology,surgical0.291546RC360Operatingroom0.404314RC370Anesthesia0.321246RC710Recoveryroom0.404314RC730EKG0.38251RC920Diagnosticservices0.88447Figure 2: Claim Information Hospital OutpatientDepartmentAdmitdate2/20/2015Dischargedate2/20/2015Sex:FAge:70LOS: 1dayAdmitdiagnosis366.9Cataract,unspecifiedPrincipaldiagnosis:366.10Senile cataract,unspecifiedPrincipalprocedure:66984Cataract extraction with IOLinsertionChargeDetailRevenueCodeCPT/HCPCSCodeCodeDescriptionCharge250$475.25270$380.25271$1178.18272$1297.07276$551.0030136415Routine venipuncture$10.0030182565Assay ofcreatinine$33.7530184132Assay ofserum potassium$33.7530185014Hematocrit$34.7531288304Tissue examby pathologist$83.5036066984Cataractextraction w/IOL$801.33370$574.00710$341.0073093005Electrocardiogram, tracing$124.5092090772Ther/proph/diaginj, sc/im$75.50TOTALCharges$5,693.83Medicare beneficiary copaymentamount:$531.88Figure 3: Claim Information Ambulatory SurgeryCenterCPT Code:66984Cataract extractionwith IOLCharges: $2,500.00Medicare beneficiary copaymentamount:$192.76Figure 4: Fee Schedule Information (CY 2012; to get current year seewww.cms.gov)RevenueCodeCPT/HCPCSFeeSchedule AmtStatusIndicator30136415$3.00A30182565$7.26A30184132$6.51A30185014$3.35AFigure 5: APC Information (CY 2012; to get current year seewww.cms.gov)RevenueCodeCPTCodeAPCRelative WeightStatusIndicator3128830403430.5262X36066984024623.8786T7309300500990.3823S9209077204361.8104S

 
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