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Payment Basis Service Fee Type of Service Type of Payer % of All Admissions

The document shows data on three diagnostic related groups (DRGs) including percentages of admissions, payment rates, and costs. For each DRG, the percentages of admissions covered by different payers are shown along with the payment rates for each payer. Joint and variable costs to deliver each DRG are also provided. The document then calculates weighted average prices and costs for each DRG, and estimates the number of patients in each DRG-payer category needed to break even on costs.

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Borey Kimyeat
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13 views

Payment Basis Service Fee Type of Service Type of Payer % of All Admissions

The document shows data on three diagnostic related groups (DRGs) including percentages of admissions, payment rates, and costs. For each DRG, the percentages of admissions covered by different payers are shown along with the payment rates for each payer. Joint and variable costs to deliver each DRG are also provided. The document then calculates weighted average prices and costs for each DRG, and estimates the number of patients in each DRG-payer category needed to break even on costs.

Uploaded by

Borey Kimyeat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Type of

Service

Type of
Payer

% of All
Admissions

DRG 1

CBHEF
GEHEF
VOUCHER
CBHI

5
8
10
2

DRG Rate 1
DRG Rate 2
DRG Rate 3
Capitation

$500
$300
$400
$600

DRG 2

CBHEF
GEHEF
VOUCHER
CBHI

9
10
12
4

DRG Rate 1
DRG Rate 2
DRG Rate 3
Capitation

$2,000
$2,200
$2,400
$3,000

DRG 3

CBHEF
GEHEF
VOUCHER
CBHI

12
10
14
4

DRG Rate 1
DRG Rate 2
DRG Rate 3
Capitation

$1,000
$900
$1,000
$1,100

Payment Basis

Service Fee

Joint Cost
Total

Fixed Cost

Variable
Costs

$50,000

$300
$300
$300
$300

$100,000

$1,200
$1,200
$1,200
$1,200

$150,000

$800
$800
$800
$800

$500,000
$800,000

DRG 1

CBHEF
GEHEF
VOUCHER
CBHI

Weighted Avearge Price


$500 =
5% x
$300 =
8% x
$400 =
10% x
$600 =
2% x

DRG 2

CBHEF
GEHEF
VOUCHER
CBHI

9%
10%
12%
4%

x
x
x
x

DRG 3

CBHEF
GEHEF
VOUCHER
CBHI

12%
10%
14%
4%
100%

x
x
x
x

$2,000
$2,200
$2,400
$3,000

$25
$24
$40
$12

=
=
=
=

$180
$220
$288
$120

$1,000 =
$900 =
$1,000 =
$1,100 =
Weighted Price

$120
$90
$140
$44
$1,303

Weighted Average VC
$300 =
5% x
$300 =
8% x
$300 =
10% x
$300 =
2% x
9%
10%
12%
4%

x
x
x
x

12%
10%
14%
4%
100%

x
x
x
x

$1,200
$1,200
$1,200
$1,200

$15
$24
$30
$6

=
=
=
=

$108
$120
$144
$48

$800 =
$800 =
$800 =
$800 =
Weighted VC

$96
$80
$112
$32
$815

Distribution of Patients by Type of DRG+Payer


DRG 1

CBHEF
GEHEF
VOUCHER
CBHI

5%
8%
10%
2%

x
x
x
x

1,639
1,639
1,639
1,639

=
=
=
=

82
131
164
33

DRG 2

CBHEF
GEHEF
VOUCHER
CBHI

9%
10%
12%
4%

x
x
x
x

1,639
1,639
1,639
1,639

=
=
=
=

148
164
197
66

DRG 3

CBHEF
GEHEF
VOUCHER
CBHI

1,639
12% x
=
1,639
10% x
=
1,639
14% x
=
1,639
4% x
=
Total Volume from different type of DRG to be break-even

197
164
229
66
$1,639

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