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What are the expected rates of reimbursement for this time frame for each payer?

What are the expected rates of reimbursement for this time frame for each payer?

Healthcare Finance: HLTH420 – 1304A 01

Unit3 – Individual Project

500-700 words

Your facility has the following payer mix:

40% commercial insurances = 800

25% Medicare insurance = 500

15% Medicaid insurance = 300

15% liability insurance = 300

5% all others including self-pay = 100

Assume that for the time in question you have 2000 cases in the proportions above. (what are the proportions of the total cases for each payer?)

(Calculated above )

The average Medicare rate for each case is $6200- 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?)

Calculating Individual Reimbursement Rates for the 5 Payers (Commercial Medicare Medicaid Liability Self pay / Other

Medicare Rate (Baseline) $6200

Commercial Insurance 110%

Medicaid 65% of Medicare

Liability Insurers 200% of Medicare

Others Average 100% of Medicare Rates

1. What are the expected rates of reimbursement for this time frame for each payer? What is your expected A/R?

2. 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.


 

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