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.

The flu vaccine payment allowance has been updated for the current year.  More information can be found here.

CMS has established payment rules for medical errors.  More information can be found here.

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.

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.