Calculate the average expected payment for each of the two procedures. What is your conclusion about the contractual allowance for these two procedures?

Posted: March 9th, 2022

You are being asked to complete task 3 on pages 195. When calculating the reimbursement for CPT 73722 (MRI of the knee) and MS-DRG 470 (major joint replacement) make you follow the the IPPS and OPPS formulas and indices information as covered in Module 3: Reimbursement Methods. Ignore the reimbursement for CPT 73722 provided on page 200; recompute this reimbursement per Module 3. Note that this health system is located Milwaukee, Wisconsin. Now assume assume that MRHS’s payer mix is 46 percent Medicare, 34 percent commercial/managed care, 16 percent Medicaid, and 4 percent self-pay/no insurance. Calculate the average expected payment for each of the two procedures. What is your conclusion about the contractual allowance for these two procedures?