# Need help calculating reimbursement



## mpekar (May 18, 2011)

Does anyone know how to calculate the expected reimbursement of an inpatient charge using DRG or who I can contact to help me figure this out? The payor is of no help. 

The service was performed in OH and the payor is Pennsylvania Medicaid. 

Total inpatient charges are $25041.10. ICD9 Dx are 198.5, 199.1, 496, 305.1, 250.80, 401.9, 780.57, 530.81, V16.1, V45.86. ICD9 procedure code is 33.26. My understanding is that there are 4 levels for DRG 544 for severity of illness and average length of stay. I found that the base rate for hospital is 4,113.22. Therefore, reimbursement can be from 1669.56, 2291.47, 2344.54 to 17,854.67. The patient stayed 6 days so I am “assuming” the last since this is for an average length of stay of 8.37 days. The DRG being used is 544. 

Please help!


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