Cost Report Blog

DSH Bonus

rvaks — Fri, 19 Feb 2010 00:00:34 +0000

DSH – Hospitals serving a large population of indigent patients may receive a DSH bonus to their Medicare payments. This is summarized by CMS in the following summary.

Hospital Outliers

rvaks — Wed, 17 Feb 2010 08:41:38 +0000

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.

Hospice Caps

rvaks — Mon, 15 Feb 2010 08:36:22 +0000

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.

Medicare GME and IME Credit

rvaks — Wed, 09 Dec 2009 17:18:51 +0000

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 (LTCH) Clarification

rvaks — Mon, 07 Dec 2009 17:13:30 +0000

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)

New Outlier Computations for HHA in 2010

rvaks — Sat, 05 Dec 2009 17:10:54 +0000

HHA Medicare payments in 2010 will have outliers computed based upon a Fixed Dollar Loss (“FDL”) of .67, compared to an FDL of .89 in 2009. The FDL is adjusted for the wage index of the HHA’s location.

OPPS Payments Increase

rvaks — Thu, 03 Dec 2009 17:08:47 +0000

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.

HHA 2010 Medicare Payment Update

rvaks — Tue, 01 Dec 2009 17:03:15 +0000

HHA 2010 Medicare payment update has a 2.0 inflation update, but 2.75% reduction for ‘unwarranted’ case mix increase, and changes in outlier payments (10% cap per agency). The Federal Register shows an increase of the base rate for 60-day episodes from $2271.92 to $2312.94 (1.8% increase).

It can be found in the Federal Register by clicking here

New HHA Caps

rvaks — Fri, 20 Nov 2009 06:48:39 +0000

Updated November 9, 2009:

For CY 2010, CMS will cap home health outlier payments at 10 percent per HHA and target total aggregate outlier payments at 2.5 percent of all HH PPS payments.

Limitation on Recoupment of Overpayments

rvaks — Mon, 16 Nov 2009 03:02:33 +0000

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.