Does anyone know how to calculate the expected reimbursement of an inpatient charge using DRG or who I can contact to help me figure this out? The payor is of no help.
The service was performed in OH and the payor is Pennsylvania Medicaid. Total inpatient charges are $25041.10. ICD9 Dx are 198.5, 199.1, 496, 305.1, 250.80, 401.9, 780.57, 530.81, V16.1, V45.86. ICD9 procedure code is 33.26. My understanding is that there are 4 levels for DRG 544 for severity of illness and average length of stay. I found that the base rate for hospital is 4,113.22. Therefore, reimbursement can be from 1669.56, 2291.47, 2344.54 to 17,854.67. The patient stayed 6 days so I am “assuming” the last since this is for an average length of stay of 8.37 days. The DRG being used is 544.
Please help!
The service was performed in OH and the payor is Pennsylvania Medicaid. Total inpatient charges are $25041.10. ICD9 Dx are 198.5, 199.1, 496, 305.1, 250.80, 401.9, 780.57, 530.81, V16.1, V45.86. ICD9 procedure code is 33.26. My understanding is that there are 4 levels for DRG 544 for severity of illness and average length of stay. I found that the base rate for hospital is 4,113.22. Therefore, reimbursement can be from 1669.56, 2291.47, 2344.54 to 17,854.67. The patient stayed 6 days so I am “assuming” the last since this is for an average length of stay of 8.37 days. The DRG being used is 544.
Please help!