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Achieve exercises such as income sensitivity and breakeven analyses for providers with diverse payer mixes.
Assess the major reimbursement sources, such as Medicare, Medicaid, and commercial insurance that affect all providers.
Differentiate the various reimbursement methods, including prospective payment systems, cost reimbursement systems, discounted charges systems, flat-rate reimbursement systems, and capitation contracts.
Evaluate healthcare relationships expressed in financial and economic terms.
Analyze and compare capital investment opportunities based on an understanding of the basics of capital budgeting and capital structure decisions.
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 2000 cases in the proportions above. (What are the proportions of the total cases for each payer?)
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?)
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