As a primary component of Medicare Disproportionate Share reimbursement, a hospital’s Supplemental Security Income (SSI) percentage plays a significant role in determining the reimbursement impact. Also referred to as the “Medicare” fraction of the Medicare DSH calculation, the SSI ratio represents the percent of patient days for beneficiaries who are eligible for both Medicare Part A and SSI. By default, SSI ratios are based on the Federal Fiscal year end (10/01 – 09/30) and are generally published annually by the Centers for Medicare and Medicaid Services (CMS). This concept makes sense for providers whose cost reporting period mirrors the federal fiscal year, but what about providers with cost reporting periods that differ from the Federal fiscal year?
Current CMS regulations allow for a hospital to request to have its Medicare fraction or SSI ratio recalculated/redetermined/realigned/enhanced based on the hospital’s cost reporting period where different from the Federal fiscal year. In practice, if a hospital’s fiscal year end is 12/31/2013, the 9/30/2013 SSI ratio would be used in the Medicare Disproportionate Share calculation. According to CMS regulations mentioned above, the SSI ratio could be recalculated to mirror the hospital’s fiscal year beginning 1/1/2013 and ending 12/31/2013 by using a combination of two Federal fiscal years of the Medicare Provider Analysis and Review (MedPAR) file. An analysis of both the 9/30/2013 AND the 9/30/2014 SSI ratio data would need to be completed to determine the hospital fiscal year SSI ratio.
Before a hospital commits to requesting an SSI redetermination though, there are a few items that should be made clear regarding the SSI patient detail data and the recalculation request process. This is the first in a series of articles relating to SSI recalculations that will address the intricacies of an SSI recalculation and while it is a fairly simple concept, much more detail is involved to determine whether a hospital should ultimately request one. Our next post addressing SSI recalculations will address the misconceptions surrounding the recalculations.
Hospitals should research annually whether their facility could benefit from an SSI realignment. In addition to Medicare DSH reimbursement reviews, SCA has vast experience in facilitating SSI recalculation data analyses and requests on behalf of its clients and has performed hundreds of SSI redetermination requests to date. Please contact us to learn more about this service and how SCA can help you determine if an SSI enhancement is in the best interest for your hospital. Don't forget to subscribe to our blog so you don't miss any posts in our SSI recalculation series!
