The managed care company has offered a five percent increase to acute inpatient services rates (per diem and CMI-based rates) if the provider agrees to a two percent decrease to case rates for ambulatory surgery, emergency department, and observation services

Critical Thinking Exercises

1. The managed care company has offered a five percent increase to acute inpatient services rates (per diem and CMI-based rates) if the provider agrees to a two percent decrease to case rates for ambulatory surgery, emergency department, and observation services

What is the net impact on reimbursement for each provision?

Is the proposal beneficial to the provider, presuming volume does not change?

What CMI base rate for medical acute inpatient services results in a break-even payment with the benchmark? What happens to payment adequacy if the CMI for medical acute inpatient services decreases to 1.0500?

The managed care company has offered a payment per chemotherapy visit, plus 50 percent of charges for chemotherapy drugs provided to patients. If $18,000,000 of the $21,000,000 in total charges is related to chemotherapy drugs, what is the break-even visit payment compared to the current payment of 60 percent of charges?