The Medicare patient presented to the emergency department with exacerbation of COPD. The patient was treated and released. The emergency department charges were $430. Two days later, the patient returned to the emergency department with congestive heart failure. The length of stay for the admission was 2 days. The inpatient charges were $4,700. The DRG amount was $3,500. The hospital should bill Medicare for:

Question

Quizplus · Accepted Answer

The hospital should bill Medicare for both the emergency department visit and the inpatient admission. Medicare will pay for both services separately, but the total amount cannot exceed the DRG amount of $3,500. Therefore, the hospital should bill Medicare for the DRG amount of $3,500 for the inpatient admission and the emergency department charges of $430, for a total of $3,930. However, since Medicare only reimburses 80% of the total charges, the hospital should receive 80% of $3,930, which is $3,144. Adding the remaining 20% not covered by Medicare, the total bill should be $3,930 + $786 (20% of $3,930) = $4,716. Therefore, the best choice is B.

The Medicare Patient Presented to the Emergency Department with Exacerbation