# the expected rates of reimbursement for this time frame

August 30, 2017

Question
Your facility has the following payer mix:
40% commercial insurances25% Medicare insurance15% Medicaid insurance15% liability insurance5% all others including self-payAssume 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?)
What are the expected rates of reimbursement for this time frame for each payer? What is your expected A/R?
What rate should you charge for these services (assuming one charge rate for all payers)?(this gives you your total A/R.) Calculate the total charges for all cases based on this rate.
What is the difference between the two A/R rates above? Can you collect it from the patient? What happens to the difference?
Which of these costs are fixed? Which are variable? Direct or indirect?
materials/supplies (gowns, drapes, bedsheets)
Wages (nurses, technicians)
Utility, building, usage exp (lights, heat, technology)
Medications
Licensing of facility
Per diem staff