Cost Report Blog

Hospitals can receive bonus payments above the DRG payment for the following reasons:

OUTLIERS – payments for very expensive cases. A CMS summary of this can be found here.

To get credit for Medicare GME and IME for Medicare HMO days, the hospital must send no-pay bills to Medicare for those days. (PRRB 2009-D20).

Long term care Hospitals (“LTCHs”) who leased space in existing hospitals could not claim inpatient capital cost reimbursement for the first two years as ‘new’ hospitals. (PRRB Hearing 2010-D2)

Medicare outpatient payments under OPPS will average a 2.1% increase in payments for 2010. Hospitals not participating in quality data reporting will receive 2% less.

Effective November 16, 2009, CMS is prohibited from recouping Medicare overpayments from a provider or supplier that seeks reconsideration from a Qualified Independent Contractor, until the date the decision on the reconsideration has been rendered. Interest paid to a provider or supplier whose overpayment is reversed at subsequent levels of appeal will now accrue from the date of the original determination.

More information can be found here.

CMS recently ammended the verification of Status for all Hospitals Qualifying for Disproportionate Share Hospital (DSH) Payments under 42 CFR Section 412.106(c)(2), also known as the “Pickle Amendment”

More information can be found in this transmittal.