CALCULATING APC PAYMENT RATES - Problem 1
|
APC
|
Relative Weight
|
Unadjusted Payment Rate
|
Wage Index for NJ
|
National Unadjusted Coinsurance
|
Minimum Unadjusted Coinsurance
|
|
005
|
5.41
|
262.31
|
1.1186
|
119.75
|
53.66
|
NATIONAL CONVERSION FACTOR: $ 48.487
The Unadjusted Payment rate is calculated by multiplying the Relative Weight x the National Conversion Factor:
___________ X $__________ = $ __________ (Should be same as above)
STEP 1: Adjusting for your area wage index. Wage index applies to 60% of the hospitals OP costs, but not to the remaining 40%. Round all answers to 2 decimal places (5th digit below 5 do not round, 5 or above round up)
$ _________ x 0.60 = $ __________
Multiply the sum by the wage index.
$ ___________ X __________ = $ __________
Add the remaining 40%.
$ ___________ X 0.40 = $ __________
Add the two sums together.
$ __________ + __________ = $ __________
STEP 2: Subtract any applicable deductible. (assume the patient still owes $50.00 toward annual deductible)
$ __________ - $50.00 = $ __________ (THIS IS YOUR ADJUSTED APC AMOUNT)
STEP 3: Calculate the Medicare payment percentage.
1. Subtract the national unadjusted coinsurance from the unadjusted payment rate.
$ __________ - $__________ = $ __________
2. Divide the answer by the unadjusted payment rate.
$ __________ / $ __________ = __________ (calculator should be set at max decimal places-DO NOT ROUND)
This is the percentage of the APC amount that Medicare will pay.
STEP 4: Multiply the adjusted APC payment by the Medicare payment percentage. (Multiply the answer in Step 2 by the answer in Step 3)
$ __________ x __________ = $ __________
STEP 5: Beneficiary Coinsurance Amount: Subtract the Medicare payment from the adjusted APC rate (subtract the answer from Step 4 from the answer in Step 2)
$ __________ - $ __________ = $ __________
STEP 6: Determine your final payment. Add the Medicare Payment + coinsurance + deductible
$ __________ + $ __________ + $ __________ = $ __________
CALCULATING APC PAYMENT RATES - Problem 2
|
APC
|
Relative Weight
|
Unadjusted Payment Rate
|
Wage Index for NJ
|
National Unadjusted Coinsurance
|
Minimum Unadjusted Coinsurance
|
|
010
|
.55
|
26.67
|
1.1186
|
9.86
|
5.46
|
NATIONAL CONVERSION FACTOR: $ 48.487
The Unadjusted Payment rate is calculated by multiplying the Relative Weight x the National Conversion Factor:
___________ X $__________ = $ __________ Should be the same as in the above grid
STEP 1: Adjusting for your area wage index. Wage index applies to 60% of the hospitals OP costs, but not to the remaining 40%. Round all answers to 2 decimal places (5th digit below 5 do not round, 5 or above round up)
$ _________ x 0.60 = $ __________
Multiply the sum by the wage index.
$ ___________ X __________ = $ __________
Add the remaining 40%.
$ ___________ X 0.40 = $ __________
Add the two sums together.
$ __________ + __________ = $ __________
STEP 2: Subtract any applicable deductible. (assume the patient still owes $10.00 toward annual deductible)
$ __________ - $10.00 = $ __________ (THIS IS YOUR ADJUSTED APC AMOUNT)
STEP 3: Calculate the Medicare payment percentage.
1. Subtract the national unadjusted coinsurance from the unadjusted payment rate.
$ __________ - $__________ = $ __________
2. Divide the answer by the unadjusted payment rate.
$ __________ / $ __________ = __________ (calculator should be set at maximum decimal places)
This is the percentage of the APC amount that Medicare will pay.
STEP 4: Multiply the adjusted APC payment by the Medicare payment percentage. (Multiply the answer in Step 2 by the answer in Step 3)
$ __________ x __________ = $ __________
STEP 5: Beneficiary Coinsurance Amount: Subtract the Medicare payment from the adjusted APC rate (subtract the answer from Step 4 from the answer in Step 2)
$ __________ - $ __________ = $ __________
STEP 6: Determine your final payment. Add the Medicare Payment + coinsurance + deductible
$ __________ + $ __________ + $ __________ = $ __________.