Spring Webinar Schedule

February 10, 2009

Revised Ambulatory Surgical Center Fee Schedule

February 9, 2009

The revised Ambulatory Surgical Center Fee Schedule Fact Sheet (January 2009), which provides general information about the Ambulatory SurgicalCenter (ASC) Fee Schedule, ASC payments, and how ASC payment amounts are determined, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network.


SNF Ambulance Responsibility

February 7, 2009

CMS has clarified in the following MLN training material that a SNF must pay for the ambulance transportation of a Medicare A patient to a doctor’s office.  More information can be found here.


Cost Report Changes

February 3, 2009

CMS has made some changes to the hospital cost report, Form CMS-2552-96 – including GME, cost reimbursement on capital for new hospitals, and capital IME.  These are summarized at Transmittal 19, below:

• Worksheet S-2 -Questions 23.01 through 24.01 are revised and/or added to capture transplant facility termination date.

  •  Questions 61 and 62 are revised to reflect the correct effective date of cost reporting periods ending on or after April 30, 2008.
  • Question 30.04 is revised to emphasize that subproviders in a CAH are reimbursed for GME on Worksheet E-3, Part IV, while the CAH is reimbursed for GME at 101 percent of reasonable cost.
  • Question 33 is revised to reflect that providers are considered new for initial cost reporting periods beginning on or after October 1, 2002 for Federal capital payment purposes.

• Worksheet S-3, Part II – Question 13 is revised to reflect the correct effective date of cost reporting periods ending on or after April 30, 2008.

• Worksheet S-5 – Questions 16 through 19 are revised to reflect the correct effective date of cost reporting periods ending on or after April 30, 2008.

• Worksheet A-8-2 – Columns 2 and 11 are revised to reflect the use of generic physician identifiers (Dr. A, Dr. B, etcetera) as opposed to confidential or traceable identifiers such as the physician’s name, NPI, UPIN or social security number, etcetera.

• Worksheet E, Part A – Questions 5, 5.01, and 5.03 are revised to replace the standard DRGs with MS-DRGs (Medicare Severity Diagnosis-Related Groups) used to calculate the additional payment amount allowable for a high percentage of ESRD beneficiary discharges pursuant to 42 CFR 412.104 as revised by the Federal Register 161, Vol. 73, dated August 19, 2008, page 48755.

  • Question 3.19 is revised to reflect the residents in teaching programs in the current year.
  • Question 24.98 is added to capture all credits received from manufacturers for replaced medical devices in accordance with change request 5680, transmittal 1509, dated May 9, 2008.
  • Question 51 is revised to correct the citation for outlier reconciliation policy.

•Worksheet E-3, Part VI – Questions 2 and 13 clarified to reflect that if the resulting reduced direct GME cap is less than zero (0), then zero must be entered on these lines.

•Worksheet I-1 – Line 17 instructions are added to clarify the calculations of ESRD costs and their relationship to worksheet A; and line 26 instructions clarify the adjustment for EPO and Arenesp.

The actual transmittal can be found here.


Capital DSH Guidelines

February 1, 2009

To claim capital DSH, a hospital must be urban and have 100 beds.

For more information, please see this Department of Health and Human Services report.