Question 1, Part I
Example for the inpatient chemical detox component and capital cost per diem
Patient is admitted to an OASAS facility certified for detox (see List). Please note that certification for a facility is very specific, down to the number of beds. Patient is admitted on April 5, 2011 and discharged on April 12, 2011 for a total stay of 7 days. On the 3rd day of the stay, the hospital determines the stay is for detox and bills the stay under Rate Code 4800.
To calculate, go to the appropriate rate sheet (4/1/11-12/31/11), locate the MMD column (RC 4800), scroll down the list of facilities and find the specific facility and find the rate located under rate code 4800. An example from the list of facilities has a rate listed at $872.20 and the amount listed for rate code 4804 is $128.91.
The instructions for a medical managed detox stay with additional days uses the following formula:
Days 1-5 (RC 4800 amount + RC 4804 amount × the number of days 1-5)
$872.20 + $128.91 = $1001.11 × 5 days = $5005.55
Days 6-10 (RC 4800 amount + RC 4804 amount multiplied by 0.5 × the number of days 6-10)
$872.20 + $128.91 = $1001.11 * 0.5 = $500.56 × 2 days (days 6 & 7)= $1001.12
Add $5005.55 + $1001.12 = $6006.67 - Total reimbursement for the stay.