Southwest Consulting Associates Blog

The FY 2020 Inpatient Skilled Nursing Facility Proposed Rule was put on display for public inspection on April 19, 2019. The proposed rule is scheduled to be published in the Federal Register April 25, 2019, however, the pre-publication can be viewed here. If finalized, this SNF rule will affect discharges on or after October 1, 2019.

The FY 2020 Inpatient Psych Proposed Rule was put on display for public inspection on April 17, 2019. The proposed rule is scheduled to be published in the Federal Register April 23, 2019. The pre-publication can be viewed here. When finalized, this IPF rule will affect discharges on or after October 1, 2019.

The Inpatient Rehab FY 2020 Proposed Rule was put on display for public inspection on April 17, 2019. The proposed rule is scheduled to be published in the Federal Register on April 24, 2019, however, the pre-publication version can be viewed here. This IRF rule will affect discharges on or after October 1, 2019.

In January, CMS issued a MLN Matters newsletter reviewing the new electronic system for Provider Reimbursement Review Board (PRRB) Medicare cost report appeals. The electronic system, referred to as OH CDMS (Office of Hearings Case and Document Management System), is a web-based portal that allows providers to submit all necessary appeals documents electronically.

Due to overwhelming response for more information on CMS’ electronic signature feature noted in “Medicare Cost Reporting – 7 Things to Know”, we’ve put together a follow up post to review the cost report electronic signature application steps.

With CMS using cost report Worksheet S-10 to determine a provider’s UC Factor 3 and ultimately their portion of federal uncompensated care payments, ensuring the accuracy of Worksheet S-10 reporting is essential for all Medicare DSH-eligible hospitals.  Now, while we know that line 30 ultimately drives Factor 3, it is recommended hospitals review ALL data on S-10, not just the data that feeds to line 30.  This includes looking closer at the cost to charge ratio (CCR) to ensure hospitals are capturing all costs that are considered allowable. As you may know, the cost to charge ratio has a direct effect on the data that is reported on Medicare cost report Worksheet S-10, which then in turn impacts UC payments.

The Centers for Medicare and Medicaid Services (CMS) has made updates to the cost reporting software, the rules for filing a hospital Medicare cost report and noted future potential changes.  Here are 7 things to know:

As stated in an earlier blog titled, “Costs for Medicare Cost Report Worksheet S-10 Cost To Charge Ratio,” hospitals need to begin looking closer at their cost to charge ratios (CCR) to ensure they are capturing all costs that are considered allowable. As you may know, the cost to charge ratio has a direct effect on the data that is reported on Medicare cost report Worksheet S-10, which then in turn impacts UC payments. In this blog, we will review the cost to charge ratio in a hospital setting. 

As CMS promised, Worksheet S-10 is now starting to be used for computing uncompensated care allocations and potentially other payment allocations in the future. It is becoming apparent that hospitals need to return to focusing more on their cost reports that are being filed to ensure costs are properly stated.

Over the past decade, many hospitals may not have focused as much on cost and charges due mostly to having PPS payment systems (excluding a discussion on Medicaid payments). While filing complete and accurate cost reports has always been the norm, now more than ever, facilities need to begin looking closer at their cost to charge ratios to ensure they are capturing all costs that can be considered allowable.  Are you capturing all your allowable costs to properly compute your cost to charge ratio for S-10?