Exercises: Calculate Expected Payments

Exercises: Calculate Expected Payments

Instructions/Descriptions

Exercises for Unit 6: Calculate Expected Payments

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Worksheet for Unit 6 Expected Payment (Use this document as your worksheet.)

Answer the questions that follow using the readings from Health Information Management: Concepts, Principles, and Practice in the PG Library and the sample computation below.

Sample 2014 RVUs for selected HCPCS Codes (Table W14.2).

Work RVU Practice Expense RVU HCPCS Code Description

RVU for Malpractice Expense

Visit to the 99203 Office 1.23 0.48 0.09

Office Visit 99204 2.00 0.71 0.12

10080 uncomplicated pilonidal cyst I&D 1.17 1.11 0.11

Colonoscopy with biopsy (45380)

4.43 1.73 0.3

Complete 52601 TURP

12.35 5.1 0.87

Sample GPCIs for selected U.S. Cities (Table W14.3).

GPCI Practice Expense GPCI Malpractice Expense GPCI City Work

1.000 0.946 0.941 St. Louis

Dallas 1.010 1.063 1.061

Seattle 1.010 1.115 0.819

Philadelphia 1.020 1.098 1.386

Calculation Example

What is the maximum amount a physician in St. Louis can bill Medicare for an office visit for a new patient with a comprehensive history and physical and low-complexity medical decision making (provided the patient has fulfilled any deductible for the year)?

[RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUm x GPCIm)] [RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUm x GPCIm)] Payment Example: x CF = x CF = x CF = x CF =

Billing 99203 in St. Louis (calculation)

1.23 multiplied by 1.000 equals 1.23

0.45 = 0.48 0.946

0.941 x 0.09 = 0.08

$59.96 = 1.76 x 34.0682

$59.96 is the answer.

Answer the following questions using the formula above, the tables, and the conversion factor from your textbook. Make sure to include all of your calculations in your presentation.

• Estimate the cost of a TURP procedure in Dallas.
• Estimate how much a colonoscopy with biopsy in St. Louis will cost.
• Determine the expected cost of a pilonidal cyst incision and drainage in Seattle.

Exercises: Calculate Expected Payments

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