Apc Calculation

CALCULATING APC PAYMENT RATES - Problem 1

NATIONAL CONVERSION FACTOR: $ 48.487

The Unadjusted Payment rate is calculated by multiplying the Relative Weight x the National Conversion Factor:

___________ X $__________ = $ __________ (Should be same as above)

STEP 1: Adjusting for your area wage index. Wage index applies to 60% of the hospitals OP costs, but not to the remaining 40%. Round all answers to 2 decimal places (5th digit below 5 do not round, 5 or above round up)

$ _________ x 0.60 = $ __________

Multiply the sum by the wage index.

$ ___________ X __________ = $ __________

Add the remaining 40%.

$ ___________ X 0.40 = $ __________

Add the two sums together.

$ __________ + __________ = $ __________

STEP 2: Subtract any applicable deductible. (assume the patient still owes $50.00 toward annual deductible)

$ __________ - $50.00 = $ __________ (THIS IS YOUR ADJUSTED APC AMOUNT)

STEP 3: Calculate the Medicare payment percentage.

1. Subtract the national unadjusted coinsurance from the unadjusted payment rate.

$ __________ - $__________ = $ __________

1. Divide the answer by the unadjusted payment rate.

$ __________ / $ __________ = __________ (calculator should be set at max decimal places-DO NOT ROUND)

This is the percentage of the APC amount that Medicare will pay.

STEP 4: Multiply the adjusted APC payment by the Medicare payment percentage. (Multiply the answer in Step 2 by the answer in Step 3)

$ __________ x __________ = $ __________

STEP 5: Beneficiary Coinsurance Amount: Subtract the Medicare payment from the adjusted APC rate (subtract the answer from Step 4 from the answer in Step 2)

$ __________ - $ __________ = $ __________

STEP 6: Determine your final payment. Add the Medicare Payment + coinsurance + deductible

$ __________ + $ __________ + $ __________ = $ __________