Southwest Consulting Associates Blog

It is not uncommon for patients to retroactively become Medicaid eligible or ineligible a few months (or longer) after a hospital’s cost report filing.  It is also not uncommon to get false positive or negative results due to the tools and methodology used to perform a Medicaid eligibility match.  As most healthcare reimbursement professionals would surely agree, retroactive Medicaid eligibility verification is especially important for its impact on a qualifying hospital’s Medicare Disproportionate Share (DSH) calculation.  When done so properly, retroactive verification of Medicaid eligible patients can confirm compliant results and yield significant increases to the Medicaid fraction of the Medicare DSH calculation.  

As discussed in a previous blog, a hospital’s Supplemental Security Income (SSI) percentage is a primary component of Medicare Disproportionate Share (DSH) reimbursement and 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).  Current CMS regulations allow for a hospital to request to have its SSI ratio recalculated based on the hospital’s cost reporting period where different from the Federal fiscal year.  But how do you determine if your hospital would benefit from a recalculation?

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?