Indiana Wesleyan University Prospective Payment System Case Study

I’m working on a management question and need an explanation to help me learn.

Background Information

A 68-year-old diabetic collapses as a result of low blood sugar while crossing a busy road and is struck by a car. The man survives but endures injuries that include a broken back, several cracked ribs, and deep wounds on both of his legs and feet from broken glass. He is hospitalized in an “IPPS” hospital; after being stabilized, he is later transferred to another “IPPS” facility for rehabilitative services to aid in his recovery. He is released in 90 days.

Instructions

1. Review the rubric to make sure you understand the criteria for earning your grade.
2. In your textbook, Health Care Finance, read:
   1. Chapter 7, “Medicare Prospective Payment Systems”
   2. Chapter 8 “Hospital Outpatient Prospective Payment System (OPPS)”
3. Study the scenario outlined in the Background Information section above.
4. Prepare a two- to three-page paper, not including cover page or reference page, with your assessment of the scenario. Your assessment should include:
   1. An assessment of the scenario as if you were responsible for billing for reimbursement
   2. An analysis of the key elements of prospective payment
   3. An explanation of the GMLOS, the hospital transfer, and how the payment rate will be determined