Medicare Cost Report Basics: Information for the TFC

Transcription

1 Medicare Cost Report Basics: Information for the TFC Transplant Financial Coordinators Association Workshop September 30, 2015 Robert Howey, CPA Revenue Cycle Manager 2015 MFMER slide-1

2 Tell me and I forget Teach me and I remember Involve me and I learn. - Benjamin Franklin 2015 MFMER slide-2

3 Objective After the session, you will be able to: Understand the preparation of the cost report and types of costs included/excluded Understand the Medicare cost report reimbursement methodology 2015 MFMER slide-3

4 Agenda I. Medicare Cost Report Overview II. Types of Organ Acquisition Costs III. Medicare Reimbursement Methodology 2015 MFMER slide-4

5 Medicare Cost Report Overview 2015 MFMER slide-5

6 What is a Medicare cost report? 2015 MFMER slide-6

7 What is a Medicare cost report? Why is it important? 2015 MFMER slide-7

8 What is a Medicare cost report? Why is it important? What are organ acquisition costs? 2015 MFMER slide-8

9 Generally, represents the necessary and reasonable costs attributable to acquiring an organ and preparing the potential donor and transplant recipient for organ transplantation MFMER slide-9

10 PRE-TRANSPLANT Evaluation Maintenance Transplant Surgery Post-Transplant I II III IV ORGAN ACQUISITION FOR RECIPIENTS ORGAN ACQUISITION FOR LIVE DONORS 1 1 Effective 11/28/11, excludes post-discharge complications 2015 MFMER slide-10

11 Types of Organ Acquisition Costs 2015 MFMER slide-11

12 Organ Acquisition Costs Direct 2015 MFMER slide-12

13 Direct Organ Acquisition Costs Dedicated Support Personnel (examples): Administrator/Manager RN Coordinator Social Worker Dietitian Financial Coordinator Appointment Schedulers Database Administrator Medical/Surgical Director 2015 MFMER slide-13

14 Direct Organ Acquisition Costs If not 100% organ acquisition activity, complete a TIME SURVEY MFMER slide-14

15 Direct Organ Acquisition Costs Other Direct Costs (examples): OPO organ fee Transplant registry fees (UNOS only) Tissue typing of donor and recipient Physician preadmission transplant evaluation Other external diagnostic testing Transportation costs for organ retrieval Surgeon procurement fee Other departmental costs 2015 MFMER slide-15

16 Direct Organ Acquisition Costs NOT considered OAC: Burial expenses for deceased donor Costs for organs sent outside the U.S. Living donor travel Services related to treatment for the underlying disease SOURCE: PROVIDER REIMBURSEMENT MANUAL (PUB. 15-1), SECTION 2773B 2015 MFMER slide-16

17 Organ Acquisition Costs Hospital Services Direct 2015 MFMER slide-17

18 Hospital Services 2015 MFMER slide-18

19 TRANSPLANT RECIPIENT SERVICES MEDICARE NON-MEDICARE HOSPITAL PHYSICIAN HOSPITAL PHYSICIAN Pre- Transplant Write-off charges and capture for cost report Reimbursed via C/R Bill to transplant hospital Bill to Payer Capture charges for cost report Bill to transplant hospital Transplant I/P Episode Bill to MAC Reimbursed DRG Bill to Carrier Reimbursed via Fee Schedule Bill to payer Bill to payer Post- Transplant Bill to MAC Reimbursed APC Bill to Carrier Reimbursed via Fee Schedule Bill to payer Bill to payer 2015 MFMER slide-19

20 TRANSPLANT LIVE DONOR SERVICES MEDICARE NON-MEDICARE HOSPITAL PHYSICIAN HOSPITAL PHYSICIAN Pre- Transplant Write-off charges and capture for cost report Reimbursed via C/R Bill to transplant hospital Write-off charges and capture for cost report Reimbursed via SAC Bill to transplant hospital Reimbursed via SAC Transplant I/P Episode Write-off charges and capture for cost report Reimbursed via C/R Bill to Carrier w/ Q3 modifier Reimbursed via Fee Schedule Write-off charges and capture for cost report Reimbursed via SAC Bill to recipient s payer Post- Transplant Follow-Up Write-off charges and capture for cost report Reimbursed via C/R Bill to Carrier w/ Q3 modifier Reimbursed via Fee Schedule Write-off charges and capture for cost report Reimbursed via SAC Bill to recipient s payer Post- Discharge Complications (effective 11/28/11) Bill to MAC Reimbursed via IPPS/OPPS Occ Code 36 Pat Rel Code 39 Bill to Carrier w/ Q3 modifier Reimbursed via Fee Schedule Bill to recipient s payer Bill to recipient s payer 2015 MFMER slide-20

21 Pre-Transplant Charge Flow: Recipients Y N N N Y Y 2015 MFMER slide-21

22 Organ Acquisition Costs Overhead Hospital Services Direct 2015 MFMER slide-22

23 Common OAC Overhead Costs Space (Square Footage) Building Equipment Plant Operations Housekeeping 2015 MFMER slide-23

24 Common OAC Overhead Costs Employee Benefits (Salaries) Cafeteria (FTEs) Administration (Accumulated Cost) Accounts Receivable (Gross Charges) Medical Records (Gross Charges) Nursing Administration (Nursing FTEs) Social Services (Time Spent) 2015 MFMER slide-24

25 Allowable Or Non-Allowable? 2015 MFMER slide-25

26 Medicare Reimbursement Methodology 2015 MFMER slide-26

27 Medicare Reimbursement Medicare Ratio Medicare Usable Organs X Total Usable Organs Medicare Organ Acquisition Reimbursement 2015 MFMER slide-27

28 Medicare Ratio Medicare Usable Organs Total Usable Organs Medicare Primary Transplants Medicare Secondary Transplants (if Medicare had some liability) Total Transplants Deceased Donor Organs Organs Sold to Other Hospitals (e.g, Paired Exchange) 2015 MFMER slide-28

29 Takeaways Accounting for TFC costs: Salary/Benefits Space Other overhead Review policies/procedures Donor/recipient financial responsibility Medicare transplants 2015 MFMER slide-29

30 2015 MFMER slide-30

31 Let s Stay in Touch! Robert Howey (904) howey.robert@mayo.edu 2015 MFMER slide-31

32 Citations for Organ Acquisition Paper Based Manuals Provider Reimbursement Manual, Part I, Chapter 27 Internet-Only Manuals (IOM) Medicare Benefit Policy Manual (Pub , Chapter 11, Section 140) Medicare Claims Processing Manual (Pub , Chapter 3, Section 90) MFMER slide-32