06 Sep 2019
Your facility has the following payer mix:
- 40% commercial insurances
- 25% Medicare insurance
- 15% Medicaid insurance
- 15% liability insurance
- 5% all others, including self-pay
Write a 3–4-page report that addresses the following requirements:
- Assume that for the time in question, you have 2,000 cases in the proportions above.
- What are the proportions of the total cases for each payer?
- The average Medicare rate for each case is $6,200. 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?
- What are the expected rates of reimbursement for this time frame for each payer? What is your expected A/R?
- 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.
- What is the difference between the two A/R rates above? Can you collect it from the patient? What happens to the difference?
- Which of the following costs are fixed, which are variable, and which are direct or indirect:
- Materials/supplies (gowns, drapes, bedsheets)
- Wages (nurses, technicians)
- Utility, building, usage exp (lights, heat, technology)
- Licensing of facility
- Per diem staff
- Insurances (malpractice, business, and so on)
- Calculate the contribution margin for one case (in $) with the following costs for this period, per case
- Materials/supplies: $2,270
- Wages: $2,000
- Utility, building, usage exp: $1,125
- Insurances (malpractice, business, and so on): $175
- Using the above information, determine which is fixed and which cost is variable. Then, calculate the breakeven volume of cases in units for this period.
- Suppose you want to make $150,000 profit between this period and next period to fund an expansion to the NICU. How many cases would you have to see? At what payer mix would this be optimal?