Archive for October 2010
Per CMS Transmittal 1981, the new Inpatient Psych PPS rates for discharges of 7/1/10 through 6/30/01 will be computed as follows:
• The Federal per diem base rate is $665.71. (This gets adjusted by DRG group , age and for which day in the inpatient stay)
• The fixed dollar loss threshold amount (for outliers) is $6,372.00.
• The labor-related share is 75.400 percent (i.e. 75.4% of the per diem rate is adjusted by the hospital’s wage index)
• The ECT rate is $286.60 (add-on for ECT shock treatment)
As before, the Medicare Cost Report of the hospital will impact the outlier calculation.
Link to the above summary can be found here.
The Federal Register for the wage indices, adjustment factors for diagnosis, age, and day of inpatient stay begins at page 23106.
CMS has announced that the Medicare Fee Schedule for physician services has been updated to apply a 2.2% increase for dates of service June 1, 2010 through November 30, 2010, rescinding the negative 21% fee schedule that was in place. (CMS Newsroom — June 25, 2010)
- In: Cost Report Training
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How does Medicare cost reporting impact us?
1 The federal government looks at cost reports to estimate profits and losses of hospitals , SNFs, Home Health Agencies, etc.
2. Providers can claim reimbursement for Medicare bad debt on their Medicare cost report for uncollectible copays and deductibles.
3. Outlier payments for expensive cases are based upon your facility-specific cost report. This would be true for both a Medicaid hospital and home health agency.
4. States base their Medicaid reimbursement upon the Medicaid cost report, but often the Medicaid auditors look to the Medicare cost report to determine how to treat certain costs or allocations found on the Medicaid report. Sometimes this Medicaid information is recorded on the Medicare cost report itself instead of a separate cost report just for Medicaid.
5. There are still elements of cost reimbursement for different health care providers. In the case of a SNF, there is still cost reimbursement of the fees of a physician who attends a Utilization Review committee, to the extent that his review relates to Medicare patients. In the case of a hospital, there is still cost reimbursement for costs related to a Nursing School or a Paramedic Education program.
6. Hospitals that receive special State subsidies for treating charity care and indigent patients are subject to a cap (known as DSH cap). The cap limits subsidies reimbursement for uncompensated costs of care of the Medicaid and other indigent patients based upon the Medicare cost report. This cap is calculated using perdiem costs and cost-to-charge ratios taken from the Medicare cost report.
7. Payment rates for hospitals and SNFs are adjusted for different locations per that location’s wage index. The wage index is based currently on hospital cost reports.
8. There are still some entities that receive cost reimbursement for all the care, such as Critical Access Hospitals.
INDIRECT MEDICAL EDUCATION (IME) PAYMENTS are payments for extra costs of additional diagnostics, etc. by using residents and interns in a teaching hospital, who are less experienced than doctors. The IME payment is calculated in teh Medicare cost report of the hospital. A CMS summary of this can be found here.
GRADUATE MEDICAL EDUCATION (GME) PAYMENTS are payments for training residents and interns in a teaching hospital. The GME payment is calculated in the Medicare cost report of the hospital. A CMS summary of this can be found here.
DSH – Hospitals serving a large population of indigent patients may receive a DSH bonus to their Medicare payments. This Medicare DSH payment is calculated in the Medicare cost report of the hospital. This is summarized by CMS in the following summary.
Hospitals can receive bonus payments above the DRG payment for outliers. Outliers are payments for very expensive cases. A CMS summary of this can be found here.
There is a cap on Medicare reimbursement for inpatient hospice care days, and also a cap for an average payment per beneficiary. Palmetto’s website has a nice summary of these caps and a calculator to calculate overpayments due to these caps. It can be found here.