Calvin Primary Care Assignment Help: How to Answer This Question

Understanding this question requires applying core subject principles.

What This Question Is About

This question relates to calvin primary care and requires a structured academic response.

How to Approach This Question

Break the problem into smaller parts and analyze each logically.

Key Explanation

This topic involves calvin primary care. A strong answer should include explanation, application, and examples.

Original Question

12. Calvin saw his primary care physician (PCP), Dr. Washington, because he had a fever and a sore throat. Dr. Washington ordered and performed a rapid strep test. Calvin’s test was positive, and he was diagnosed with streptococcuspharyngitis (strep throat). Dr. Washington wrote Calvin a prescription for amoxicillin to treat the pharyngitis. Dr. Washington submitted the following charges to Calvin’s insurance company, Super Payer: Clinic visit, level 2 – $145 Rapid strep test – $50 Dr. Washington’s practice has a contract with Super Payer and the reimbursement methodology is a fee schedule. The fee schedule rate for a level 2 clinic visit is $70 and the fee schedule rate for a rapid strep test is $10. What is the total reimbursement Dr. Washington will receive for Calvin’s office visit? 13. Super Payer has a contract with Community Hospital to provide inpatient care for their beneficiaries. They have agreed to a per diem reimbursement methodology. ICU days are reimbursed at $5,000 per day and medical bed days are reimbursed at $3,500 per day. Community Hospital submitted a claim for a six-day length of stay (LOS). Two of the six days were ICU days and four of the six days were medical bed days. What is the total reimbursement owed to Community Hospital for this admission? 14. Super Payer has a contract with Memorial Hospital for inpatient surgical admissions. They have agreed to a case-rate methodology for these admissions. The case rate for a coronary artery bypass graft surgical admission is $28,500. Memorial Hospital submitted claims for the following admissions: Admission # Surgery LOS Charges Cost Coronary 123 artery bypass 5 $78,050 $27,317 graft Coronary 124 artery bypass 6 $84,400 $29,540 graft Coronary 126 artery bypass 5 $79,450 $27,808 graft What is the total reimbursement Memorial Hospital will receive for all 3 admissions? 15. Dr. O-Neil’s physician practice has a PMPM contract with Super Payer to provide primary care services. Super Payer uses a risk adjustment model to determine the PMPM amounts. The beneficiary risk score breakouts are provided below: Number of Beneficiaries Risk Score Level PMPM Amount 100 1 – 1.00 risk score $200.00 135 2 – 1.25 risk score $250.00 150 3 – 1.50 risk score $300.00 125 4 – 1.75 risk score $350.00 90 5 – 2.00 risk score $400.00 How much reimbursement will Dr. Oneil’s physician practice receive each month from Super Payer to provide primary care for the 600 beneficiaries? 16. What is the main goal of the CMS-HCC risk adjustment model? 17. Describe how diagnosis coding impacts reimbursement under the CMS-HCC risk adjustment model. 18. Super-ACO had benchmark expenses of $2.5 million and performance year expenses of $2.2 million. How much total savings was achieved by Super-ACO? If the shared saving percentage is 50 percent, how much shared savings would Super-ACO receive? 19. Super-ACO is deciding whether to convert to a two-sided risk for the next year. The shared saving rate is 75 percent, and the shared loss rate is 30 percent for the track that is under consideration. Estimate the gain for the two-sided risk model if the actual expenses for the next year are 10 percent below the benchmark of $2.5 million. 20. Super-ACO is deciding whether to convert to a two-sided risk for the next year. The shared saving rate is 75 percent, and the shared loss rate is 30 percent for the track that is under consideration, Estimate the Joss for the two-sided risk model if the actual expenses for the next year are 10 percent above the benchmark of $2.5 million.

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."