Medicare Reimbursement Update and Financial Improvement Tools for Rural Hospitals
|
|
- Dorcas Stafford
- 6 years ago
- Views:
Transcription
1 acumen Medicare Reimbursement Update and Financial Improvement Tools for Rural Hospitals Presented by Ann King White, CPA BKD, LLP June 15, 2017 insight ideas attention reach expertise depth agility talent Agenda Reimbursement Update Current Status for CAH hospitals Medicare Inpatient PPS Proposed Rule - FFY 2018 Final Rule CY 2017 for OPPS and Other Providers Preparing for the Future CAH Metrics and Financial Measures 1. Profitability 2. Revenue 3. Liquidity 4. Capital Structure 5. Operational Measures 15th Annual Western Region Flex Conference Flex Conference Hospital Analysis Analysis of Western CAHs including Hospital s attending the conference Medicare cost reports from FYE 2015 & 2016 Obtained from on-line Cost Report service CAH Hospitals census = 138 From 8 Western States including: AZ, CA, CO, HI, ID, NM, NV, UT, WY Hospital Conference Attendees = 30 Average Bed Size Hospital average bed size at 19 Smallest at 2, Largest at 25 Reimbursement Update Inpatient PPS (IPPS) FFY 2018 Proposed and FFY 2017 Final Rule 1
2 Reimbursement Current Status for CAHs Hospitals FFY 2018 IPPS Proposed Rule Published on 4/14/17 CAH hospitals on holding pattern, same as PY Sequestration at 2% cut all Health Care Cost Reimbursement still at 1% less 2% = 99% But this is an area that has brought discussion to reduce by 1% So From 1% reimbursement to 0%, then with 2% sequestration would mean reimbursement at 98% Comments accepted through 6/13/17 Final Rule expected in August, effective /1/17 for FFY 2018 Limited comments specific to CAHs Impact for Quality Reporting and MU 7 FFY 2015 Submit Quality Data & meets MU Submit Quality Data & does not meet MU Did not submit Quality Data & meets MU Did not submit Quality Data & does not meet MU Market Basket Rateof-Increase 2.90% 2.90% 2.90% 2.90% Quality Data Adjustment (0.725) (0.725) MU Adjustment 0.00 (2.175) 0.00 (2.175) MFP Adjustment (0.40) (0.40) (0.40) (0.40) Documentation & Coding (0.75) (0.75) (0.75) (0.75) Operating Payment Rate 1.75% (0.425) 1.025% (1. 15%) Wage Index Issues 8 Does not Apply to CAH s No Proposed changed to the Frontier Policy Frontier states (Montana, North Dakota, South Dakota, Wyoming & Nevada) guaranteed 1.0 WI Proposed national average hourly wage Proposed $41.96 in 2018 Prior year final was $41.07 or 1.9% increase Methodology If a hospital terminated data remains in the WI unless not reasonable If a hospital has become a CAH before 1/23/17, data excluded Reclassification Currently 906 hospitals are reclassified For FFY 2019 must apply by 9/1/17 2
3 DSH & UNCOMPENSATED CARE Uncompensated Care FY 2018 and after To begin using S- data for allocation of uncompensated care beginning in FY 2018 To be consistent with FY 2017 proposed changes, use 3 years of cost report data for S- allocation Medicaid days from FY 2012 and FY 2013 cost reports FY 2014 and FY 2015 published SSI ratios. FY 2014 S- uncompensated care data DSH UNCOMPENSATED CARE PAYMENTS Key takeaways The increase in the Factor 1 uncompensated care pool and the change in the Factor 2 methodology may mask the true impact of using Worksheet S- uncompensated care data. Maintain auditable documentation for charity care and bad debt amounts Comply with Worksheet S-, Transmittal Still lots of unanswered questions: Example: Presumptive charity care eligibility RURAL DEMONSTRATION PROJECT Extension for an additional 5-year period. Participating hospitals can continue. CMS released the requests for applications in April 2017 and announcement of participating hospitals in June Maximum of 30 participating hospitals. Any rural community hospital in any State can submit an application. However priority will be granted to hospitals in the 20 states with the lowest population densities. (Alaska, Arizona, Arkansas, Colorado, Idaho, Kansas, Maine, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, Vermont, and Wyoming) Propose the periods of performance for previously and newly selected hospitals would start with the hospital s first cost reporting period on or after October 1, PROPOSED CHANGES TO CAH HOSPITALS Last year CMS is selected CAHs to participate in the Frontier Rural Community Health Integration Project Demonstration (FCHIP) Developed to test new models for the deliver of health care services, improve access, and better integrate delivery of acute care to Medicare beneficiaries Period of performance August 1, 2016 July 31, 2019 Goal is to maintain budget neutrality for the demonstration project Any increase in Medicare payments will be recouped from all CAHs through a reduction in Medicare payments over a three year period of cost reporting years, beginning in calendar year So CMS notes there is no impact on FY
4 REVIEW OF CAH 96-HOUR CERTIFICATION REQUIREMENT CMS proposed to direct QIOs, MACs, SMRCs and RACs to make the 96-hour cert. a low priority for medical records reviews. Effective for review conducted after /1/2017 Covers the rule where a physician certifies patient can be discharge/transferred in 96-hours Unless there is probably fraud, waste or abuse Other reviews, such as by OIG, DOJ or ZPICs are not effected MEDICARE COST REPORTING AND PROVIDER REQUIREMENTS Electronic Signature and Submission: Historically the provider has been required to submit a hard copy of the settlement summary with original signature; under proposed rule the provider will be able sign the certification page via electronic signature or original signature A checkbox will be added to indicate if signing electronically on the settlement page If signed electronically, the provider can submit the Certification and Settlement Summary page in the same manner the MCR cost report is submitted (electronically versus hard copy) QUALITY REPORTING E. Clinical Quality Measurement for Eligible Critical Access Hospitals (CAHs) Participating in the EHR Incentive Programs Program includes incentive payments under Medicare and Medicaid for adoption and meaningful use of certified electronic health record technology (CEHRT) by reporting of CQMs or ecqms Proposed reporting period changes: CY 2017: 2 self selected quarters of CQM data in 2017 instead of full calendar year CY 2018: first 3 quarters of CY 2018 Proposed CQM changes: CY 2017: report on at least 6 (self-selected) CQMs instead of 8 CY 2018: report on at least 6 (self-selected) CQMs instead of 8 QUALITY REPORTING F. Clinical Quality Measurement for Eligible Professionals (EPs) Participating in the Medicaid EHR Incentive Program in 2017 Proposed reporting period changes: CY 2017: minimum of a continuous 90-day period during the CY Proposed CQM changes: Align CQMs available in the Medicaid EHR Incentive Program with those available in the Merit-based Incentive Payment System (MIPS) For CY 2017, report on any 6 CQMs that are relevant to scope of practice 4
5 Acute Care Volume Indicators Western CAHs Analysis compared to most profitable Western CAHs Acute Care Averages Volume differences Acute M/C Days Median 7 compared to 1,274 Conference Attendees M/C Days 684 Total Days Median 1,396 compared to 2,742 Conference Attendees Total Days 1,337 Acute Care Reimbursement Western CAHs Analysis compared to most profitable Western CAHs Acute Care Average Reimbursement per day (Median) Acute M/C $2,346 compared to $2,120 Conference Attendees $2,062 Ancillary M/C $1,385 compared to $2,746 Conference Attendees $1,446 Total M/C Payment $3,731 compared to $4,866 Conference Attendees $3,508 Swing Bed Comparison What is your utilization? M/C Days 1 to 2,6 (Average 491) Conference Attendees Average SB M/C Days = 444 Top Western CAH s Average SB M/C Days = 456 M/C Utilization 19% to 0% Does it help your bottom line? What are the threats to this good reimbursement? What are opportunities to collaborate related to CJR Comprehensive Care for Joint Replacement and other upcoming payment bundles? Reimbursement Regulations CY 2017 Final Rule for Outpatient OPPS and Other Providers 5
6 FY 2017 OPPS Final Rule Conversion factor update of 1.9% after productivity and other adjustments CY12: $ CY13: $ (1.59% increase) CY14: $ (2.17% increase) CY15: $ (2% increase) CY16: $ (1.9% increase) CY 17: $ (1.65% increase) Outpatient Indicators and Reimbursement Western CAHs compared to most profitable Western CAHs at the Average Outpatient Cost to Charge Ratios 50% to 38% -- Attendees 53% Outpatient Medicare Revenue per Calendar Day $30,116 to $76,530 Attendees $26,596 Outpatient Medicare Cost to Allowable Cost Percentage 26% to 14% --Attendees 22% RHC Rates -- CY 2017 Upper Payment Limit per visit (Does not apply to CAHs) Increase, rates in: 2015 = $ = $ = $82.30 Reflects a 1.2% payment increase Flex Attendees with RHCs (Limit does not apply) Average Per Visit cost = $220 (over limit get + $138 ) IMPORTANT Billing Changes and Reimbursement Opportunities for RHCs and Rural Providers including Chronic Care Management (CCM) and Advanced Care Planning (ACP) Rate Changes for Other Providers 2017 SNF - Overall rate increase = 2.4% HHA Overall rate decrease = (0.7%) Hospice Overall rate increase = 2.1% 6
7 Preparing for the Future CAH Metrics and Financial Measures Financial Indicators and Comparison Benchmarks 1. Profitability 2. Revenue 3. Liquidity 4. Capital Structure 5. Operational Measures Profitability Profitability 7
8 Goals for Profitability Hospitals need to look for ways to be More Efficient Cost Effective In the delivery of Services Keep in mind the Triple Aim: Increase efficiency in providing care Improve the patient experience Improve outcomes Western CAHs Profitability Cost Report data (12/31/2015 & 6/30/2016) Net Operating Income (Net Patient Revenue less Expenses) 56 CAHs or 41% had Positive Net Income from Operations (PY 34%) 82 CAHs or 59% had Net Operating Losses -- Average Loss ($2,200,000) Attendees Net Operating Income 14 CAHs or 47% had Positive Net Income from Operations 16 CAHs or 53% had Net Operating Losses -- Average Loss ($2,400,000) Western CAHs Profitability Cost Report data (12/31/2015 & 6/30/2016) Net Income (including Other Income) 1 CAHs or 80% were Profitable ( PY 75%) 28 CAHs or 20% had Net Losses -- Average Loss ($1,080,000) Attendees Net Operating Income 24 CAHs or 80% had Positive Net Income from Operations 6 CAHs or 20% had Net Operating Losses -- Average Loss ($818,000) Total Margin % (Average) Western Attendees Top A BBB CAHs 7 6 8
9 EBIDA Margin % (Average) Western Attendees Top A BBB CAHs Revenue Acute Medicare Utilization Low Mid High Average Attendees Top 9
10 Acute Medicaid Utilization Low Mid High Average Attendees Top Western CAHs Outpatient Revenues Cost Report data (12/31/2015 & 6/30/2016) Outpatient revenue to Total Revenue Range from 55% to 98% Median for Western CAHs was 78%, One major source of outpatient revenue was from RHC Clinics Analyze for your hospital where the largest sources of outpatient revenue are and look at departments and specific services. Outpatient Revenue to Total % Low High Western Average Top Outpatient Medicare Utilization Low High Western Average 25 Top
11 Improve Revenue Realization Analyze charge payer % s by procedure Restructure charges to take advantage of procedures with higher % of charge payers OR consider reducing charges to capture market share for competitive pricing and consumer shopping Update the hospital s Charge Description Master (CDM) 41 Take a closer look at Medicare Payments Re-examine that all Medicare payments are correct Verify the relationship between coding and payments How Do Your Third Party Payers pay... Depends on the payer and services provided to the patient Fee for service Fixed payments Payments based on Medicare methodology Contracts with payer AUDIT these payments 11
12 Medicare Bad Debts All Medicare Bad Debts are reimbursed at 65% Western CAH s Average for Inpatient Deductibles & Co-Insurance Average = $209,805 Average Bad Debts $20,140 or 9.6% Western CAH s Average for Outpatient Deductibles & Co-Insurance $1,863,129 Average Bad Debts $188,124 or % Hospitals with No Medicare Bad Debts- 22 or 16% Attendees overall had 7% Medicare Bad Debts Western CAHs Medicare Bad Debts Inpatient Bad Debts 15% 2% 1% No Bad Debts 11% 47% 24% Under $25,000 Under $50,000 Under $0,000 Under $250,000 Over $250,000 Outpatient Bad Debts 17% 19% Bad Debts to Deductibles & Co-Insurance is 8% 9% 17% 16% 22% Liquidity Western CAHs Liquidity Cost Report data (12/31/2015 & 6/30/2016) Current Ratio range from 1.82 to 5.08 Average 3.92 (Attendee Average 4.15) Days Cash on Hand range from negative 27 to 167 Days Cash is still King Average 122 Days (Attendee Average 143 Days) Net Days in Accounts Receivable range from 43 to150 Days Average 56 Days (Attendee Average 52 Days) 12
13 Current Ratio Low Mid High Average Attendees Top Days Cash on Hand Including Investments Low Mid High Attendees Top A RatedBBB Rated Net Days in Accounts Receivable Capital Structure 0 Western Average Attendees Top A Rated BBB Rated 13
14 Debt to Capitalization (%) Western Average Top AA A BBB 36 Debt Financing A word of caution Typical financing structures (i.e. long-term revenue bonds) for major facility improvements can generate strong cash flow in early years but could have insufficient cash flow to make the payments in later years CHA cost reimbursement higher in early years from Depreciation and Interest Important to understand your forecast model Operational Measures Average Daily Census Acute Beds & Swing Beds Acute Acute Acute Top SB SW SB Top Western Attendees Western Attendees CAH's CAH's 14
15 Staffing Levels Hospital s largest cost Average FTE s Western CAH s = 175 (Average Salary per FTE = $62,879) Attendees = 176 (Average Salary per FTE = $62,217) Western Top = 340 (Average Salary per FTE = $78,637) Prepare an FTE analysis If you cannot benchmark yourself get help Then take action with a Staffing Plan Then budget to the agreed plan Reduce/eliminate agency staffing Goal is to manage staffing Medicare Cost Report Worksheet S- Uncompensated Care Uses overall Cost to Charge Ratios (CCR) But we know excludes: Selected costs to do business that Medicare does not share in Physician services Other sub-providers part of organization Western CAH s overall Average CCR = 62% Attendees overall Average CCR = 65% Top CAH s overall Average CCR = 49% 58 Prepare for the Future Fine tune operations Revenue Cycle Medicare Cash Flow Staffing Levels Adequate Medical Staff Evaluate & consider eliminating unprofitable services, carefully evaluate new services How do you increase revenues without increasing costs? If the future is keeping patients well thus less health care costs? What resources do you need? Is the future focus on Community and Health? 15
16 Thank You Contact Information Ann King White, CPA Denver, CO
CAH Metrics and Financial Measures
acumen CAH Metrics and Financial Measures Presented by Ann King White, CPA BKD, LLP August 5, 2015 AZ Rural Flex Program 2015 Performance Improvement Summit Financial Indicators and Comparison Benchmarks
More informationCAH Financial Indicators Report: Summary of Indicator Medians by State
Flex Monitoring Team Data Summary Report No. 18: : Summary of Indicator Medians by State March 2016 The Flex Monitoring Team is a consortium of the Rural Health Research Centers located at the Universities
More informationCAH Financial Indicators Report: Summary of Indicator Medians by State
Flex Monitoring Team Data Summary Report No. 26: CAH Financial Indicators Report: Summary of Indicator Medians by State March 2018 The Flex Monitoring Team is a consortium of the Rural Health Research
More informationThe Leader in Medicare Cost Report Software. HFS Update. Luke DiSabato Health Financial Systems
The Leader in Medicare Cost Report Software HFS Update Luke DiSabato Health Financial Systems 2552-10 TRANSMITTALS 11/12/13 Major Changes Worksheet S-10 clarifications (T-11) Transmittal 12/13 Electronic
More informationJim Frizzera, Principal Health Management Associates
Jim Frizzera, Principal Health Management Associates Established the Medicaid disproportionate share hospital (DSH) adjustment. Required States to set Medicaid reimbursement rates for hospital inpatient
More informationWhat Hospitals Need to Know About Cost Report Changes
What Hospitals Need to Know About Cost Report Changes Sue Brammer Partner, Kansas City Kevin Wellen Senior Managing Consultant, St. Louis To receive CPE credit: Participate in the entire webinar Answer
More informationNew IPPS Regulations & Cost Report Forms ( ) Hospital Finance & Reimbursement Workshop Columbia, SC November 15, 2011
New IPPS Regulations & Cost Report Forms (2552-10) Hospital Finance & Reimbursement Workshop Columbia, SC November 15, 2011 Disclaimer All information provided is of a general nature and is not intended
More informationDaniels Memorial Health Care Center
Daniels Memorial Health Care Center Presentation to the Board of Directors November 19, 2015 Financial Date Statements or subtitle For the Year Ended June 30, 2015 www.wipfli.com 1 Table of Contents Required
More informationThe Financial Impact of the American Health Care Act s Medicaid Provisions on Safety-Net Hospitals
The Financial Impact of the American Health Care Act s Medicaid Provisions on Safety-Net Hospitals Technical Appendix Dobson DaVanzo & Associates, LLC Vienna, VA 703.260.1760 www.dobsondavanzo.com The
More informationA Primer on Financial Ratio Analysis and CAHMPAS
A Primer on Financial Ratio Analysis and CAHMPAS CAHMPAS Team North Carolina Rural Health Research and Policy Analysis Center Cecil G. Sheps Center for Health Services Research 725 Martin Luther King,
More informationTips and Tricks For Understanding Worksheet S-10. Presented By Ellen Donahue, Senior Manager October 3, 2017
Tips and Tricks For Understanding Worksheet S-10 Presented By Ellen Donahue, Senior Manager October 3, 2017 Objectives 1 DESCRIBE 2 DESCRIBE S-10 HOW S-10 WILL IMPACT DSH 3 APPLY WHAT YOU KNOW ABOUT S-10
More informationMEDICAID: STATE DISPROPORTIONATE SHARE HOSPITAL ALLOTMENT REDUCTIONS FOR FYs 2014 AND 2015 SUMMARY
MEDICAID: STATE DISPROPORTIONATE SHARE HOSPITAL ALLOTMENT REDUCTIONS FOR FYs 2014 AND 2015 SUMMARY On May 15, 2013, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register
More informationA Primer on Ratio Analysis and the CAH Financial Indicators Report
A Primer on Ratio Analysis and the CAH Financial Indicators Report CAH Financial Indicators Report Team North Carolina Rural Health Research and Policy Analysis Center Cecil G. Sheps Center for Health
More informationCurrent State of Medicare. Robert Roth & John Hellow Hooper, Lundy & Bookman, PC
Current State of Medicare Robert Roth & John Hellow Hooper, Lundy & Bookman, PC Rule for FY 2016 A. FY 2017 Final Rule Released Aug. 2, 2016 (printed in Federal Register Aug. 22, 2016) B. FY 2018 Proposed
More informationCurrent State of Medicare
Current State of Medicare Robert Roth & John Hellow Hooper, Lundy & Bookman, PC Rule for FY 2016 A. FY 2017 Final Rule Released Aug. 2, 2016 (printed in Federal Register Aug. 22, 2016) B. FY 2018 Proposed
More informationForm CMS Transmittal 13 Changes
Form CMS-2552-10 Transmittal 13 Changes Compu-Max 2552-10 Version 2018.01 February 9, 2018 Form CMS-2552-10 Transmittal 13 Changes - Contents Review of significant changes in Form CMS-2552-10, Transmittal
More informationMedicare DSH & Worksheet S-10. Kentucky HFMA March 29, 2018
Medicare DSH & Worksheet S-10 Kentucky HFMA March 29, 2018 Medicare DSH DSH Disproportionate Share Hospital Original intent was to provide additional reimbursement under PPS for hospitals that incur higher-than-average
More informationMedicare Payment Cut Analysis November 2013 Update -Version 1, November 2013-
Medicare Payment Cut Analysis November 2013 Update -Version 1, November 2013- Analysis Description The Medicare Payment Cut Analysis November 2013 Update is intended for advocacy purposes and to support
More information4012 FORM CMS
4012 FORM CMS-2552-10 09-17 4012. Worksheet S-10 - Hospital Uncompensated and Indigent Care Data--Section 112(b) of the Balanced Budget Refinement Act (BBRA) requires that short-term acute care hospitals
More informationMEDICAID: STATE DISPROPORTIONATE SHARE HOSPITAL ALLOTMENT REDUCTIONS FOR FYs 2014 AND 2015 FINAL RULE SUMMARY. September 17, 2013
MEDICAID: STATE DISPROPORTIONATE SHARE HOSPITAL ALLOTMENT REDUCTIONS FOR FYs 2014 AND 2015 FINAL RULE SUMMARY September 17, 2013 On September 13, 2013, the Centers for Medicare & Medicaid Services (CMS)
More informationCRS Report for Congress
Order Code RS21071 Updated February 15, 2005 CRS Report for Congress Received through the CRS Web Medicaid Expenditures, FY2002 and FY2003 Summary Karen L. Tritz Analyst in Social Legislation Domestic
More informationWage Index Training NWO HFMA. February 15, 2018
Wage Index Training NWO HFMA February 15, 2018 What is Wage Index? Section 1886(d)(3)(E) of the Social Security Act, Adjusting for Different Area Wage Levels, requires that as part of the methodology for
More informationAppendix I: Data Sources and Analyses. Appendix II: Pharmacy Benefit Management Tools
Appendix I: Data Sources and Analyses This brief includes findings from analyses of the Centers for Medicare & Medicaid Services (CMS) State Drug Utilization Data 1 and CMS 64 reports for federal fiscal
More informationWikiLeaks Document Release
WikiLeaks Document Release February 2, 2009 Congressional Research Service Report RS21071 Medicaid Expenditures, FY2003 and FY2004 Karen Tritz, Domestic Social Policy Division January 17, 2006 Abstract.
More informationCost Reporting 101: Your Medicare Cost Report from A - M
Cost Reporting 101: Your Medicare Cost Report from A - M Paul Traczek, CPA, Partner Holly Pokrandt, CPA, Partner September 27, 2018 Cost Reporting 101: A Crash Course in the Basics What will be covered
More informationUncompensated Care Payments and Worksheet S-10. HFMA Maine Chapter
Uncompensated Care Payments and Worksheet S-10 HFMA Maine Chapter January 11, 2018 Disproportionate Share & Uncompensated Care Payments 2 Medicare DSH Payments Total payment is the sum of the following:
More information2. METHODS AND DATA. Trends in AAPCC capitation rates with comparisons for metropolitan and nonmetropolitan
2. METHODS AND DATA The trend analysis results presented in this report encompass six distinct areas of research. The general research strategy was to analyze trends in Medicare payments during the 1990s
More information(Cont.) FORM CMS Line For cost reporting periods that overlap October 1, 2013 and subsequent years, enter the amount of the
11-16 FORM CMS-2552-10 4030.1 4030. WORKSHEET E - CALCULATION OF REIMBURSEMENT SETTLEMENT Worksheet E, Parts A and B, calculate title XVIII settlement for inpatient hospital services under the inpatient
More informationWhat Medicare Providers Need To Know About the IPPS/OPPS Final Rules and the Bipartisan Budget Act
What Medicare Providers Need To Know About the IPPS/OPPS Final Rules and the Bipartisan Budget Act Los Angeles San Francisco San Diego Washington D.C. 2 Actual and Projected Medicare Spending 3 A. Market
More informationRev. 12 FORM CMS ( ) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION )
COMPLEX IDENTIFICATION DATA FROM PART I Hospital and Hospital Health Care Complex Address: 1 Street: P.O. Box: 1 2 City: State: ZIP Code: County: 2 Hospital and Hospital-Based Component Identification:
More informationCritical Access Hospital (CAH) ND Critical Access Hospital Board Boot Camp April 13, 2018
Critical Access Hospital (CAH) Financial Analysis 2016, ND CAH ACO Experiences, Plans and Possibilities ND Critical Access Hospital Board Boot Camp April 13, 2018 1 Support for the Financial Analysis The
More informationHFMA s Regulatory Sound Bites. An Overview of the Final 2019 Inpatient Prospective Payment System Rule & Quick look at the Proposed 2019 OPPS
HFMA s Regulatory Sound Bites An Overview of the Final 2019 Inpatient Prospective Payment System Rule & Quick look at the Proposed 2019 OPPS Presentation Objectives Review the 2019 Final Medicare Inpatient
More informationCoverage Expansion [Sections 310, 323, 324, 341, 342, 343, 344, and 1701]
Summary of the U.S. House of Representatives Health Reform Bill October 2009 The following summarizes the major hospital and health system provisions included in the U.S. House of Representatives health
More informationRHC Medicare Cost Reporting 101 Katie Jo Raebel, CPA, Partner March 20, 2019
RHC Medicare Cost Reporting 101 Katie Jo Raebel, CPA, Partner March 20, 2019 Wipfli LLP Critical Access Hospital and Rural Health Clinic Conference 0 Today s Agenda Rural Health Clinic Medicare Cost Report
More informationSmall Rural Hospital Transition (SRHT) Project Guide
Small Rural Hospital Transition (SRHT) Project Guide Understanding the Hospital Medicare Cost Report Uncompensated and Indigent Care Data Form CMS-2552-10 (Worksheet S-10) September 22, 2015 525 S. Lake
More informationBudget Uncertainty in Medicaid. Federal Funds Information for States
Budget Uncertainty in Medicaid Federal Funds Information for States www.ffis.org NCSL Legislative Summit August 2017 CHIP Funding State Flexibility DSH Cuts Uncertainty Block Grant ACA Expansion Per Capita
More informationCT Nursing Facilities 2017 Legislation: Reimbursement Presentation to the Membership of CAHCF. December 7, 2017
CT Nursing Facilities 2017 Legislation: Reimbursement Presentation to the Membership of CAHCF Vincent Ruocco, CPA Partner vruocco@odpkf.com December 7, 2017 Discussion CT Medicaid rates effective July
More informationHighlights. Percent of States with a Decrease in MH Expenditures from Prior Year: FY2001 to 2010
FY 2010 State Mental Health Revenues and Expenditures Information from the National Association of State Mental Health Program Directors Research Institute, Inc (NRI) Sept 2012 Highlights SMHA Funding
More informationData Note: What if Per Enrollee Medicaid Spending Growth Had Been Limited to CPI-M from ?
Data Note: What if Per Enrollee Medicaid Spending Growth Had Been Limited to CPI-M from 2001-2011? Rachel Garfield, Robin Rudowitz, and Katherine Young Congress is currently debating the American Health
More informationWisconsin Hospital Association
Wisconsin Hospital Association Wage Index Improvement Program & Occupational Mix PPS 31 (FY 2018 AWI) FYE between September 30, 2014 and August 31, 2015 Presented on July 20, 2016 Contact Information WHA
More informationPredictive Qualifying Alternative Payment Model (APM) Participants (QPs) Methodology Fact Sheet What is the Predictive QP Status Analysis?
Predictive Qualifying Alternative Payment Model (APM) Participants (QPs) Methodology Fact Sheet What is the Predictive QP Status Analysis? One of the Quality Payment Program s goals is to be clear about
More informationNavigating ZPIC Audits: Challenges and Solutions for Health Care Providers
Navigating ZPIC Audits: Challenges and Solutions for Health Care Providers American Health Care Association (AHCA) Scot T. Hasselman and Rahul Narula April 24, 2012 Navigating ZPIC Audits Today s Topics
More informationUS Geological Survey Streamflow Information Program. Western States Water Council Meeting 07/17/2014
US Geological Survey Streamflow Information Program Western States Water Council Meeting 07/17/2014 Streamgage Network Budget National Streamflow Information Program and the Cooperative Water Program Historical
More informationTable 1: Medicaid and CHIP: December 2016 and January 2017 Preliminary Monthly Enrollment
Table 1: Medicaid and CHIP: December 2016 and January 2017 Preliminary Monthly Enrollment Performance Indicator Information: The Medicaid and CHIP performance indicators were developed in consultation
More informationMedicaid & CHIP: March 2015 Monthly Applications, Eligibility Determinations and Enrollment Report June 4, 2015
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Medicaid & CHIP: March 2015 Monthly Applications,
More informationReimbursement & Cost Report Strategies. Reducing cost is NOT always the solution.
Reimbursement & Cost Report Strategies Reducing cost is NOT always the solution. 1 Summary Reimbursement cuts = organizations reduce costs Some fixed cost cuts help bottom line, others harm Other reimbursement
More informationPayment Strategies That Enhance Payer Equity, Charge Position, and Yield. Jamie Cleverley, MHA William Cleverley, PhD
Payment Strategies That Enhance Payer Equity, Charge Position, and Yield Jamie Cleverley, MHA William Cleverley, PhD Today s Objectives 1) Evaluate internal and external payer equity to determine if payment
More informationMoving Medicaid Forward in Florida
Moving Medicaid Forward in Florida Florida Health Care Affordability Summit Cindy Mann Partner, Manatt Health April 26, 2016 Agenda 2 The New Medicaid Medicaid in Florida: Current State Landscape The Road
More informationTools for State Transformation: To Waiver or Not?
1 Tools for State Transformation: To Waiver or Not? Prepared for the National Conference of State Legislatures December 8, 2015 By Cindy Mann Agenda 2 Background 1115 Waivers 1332 Waivers & Coordinated
More informationAZ, DE, FL, MD, MO, NY
MSIS Table Notes Tables 1, 1a Enrollment General notes Enrollment estimates are rounded to the nearest 100. Spending data in MSIS do not include Disproportionate Share Hospital (DSH) payments. "Enrollees"
More informationTrends in Alternative Medicaid Coverage Initiatives
1 Trends in Alternative Medicaid Coverage Initiatives April 21, 2015 Jocelyn Guyer, Director Manatt Health Principles Driving Alternative Coverage Initiatives 2 Preserve and strengthen private coverage
More informationMedicaid & CHIP: August 2015 Monthly Applications, Eligibility Determinations and Enrollment Report
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Medicaid & CHIP: August 2015 Monthly Applications,
More informationUnderstanding and evaluating block grants and other capped funding proposals. Manatt Health January 17, 2017
Understanding and evaluating block grants and other capped funding proposals Manatt Health January 17, 2017 Agenda Medicaid Today Alternative Financing Structures Key Policy and Implementation Considerations
More informationIf you have any other questions, please feel free to call us at MEDICARE ( ). Sincerely,
Thank you for your recent request for the Patient s Request for Medical Payment form (CMS 1490S). Enclosed is the form, instructions for completing it, and where to return the form for processing. Please
More informationTHE COST OF NOT EXPANDING MEDICAID
REPORT THE COST OF NOT EXPANDING MEDICAID July 2013 PREPARED BY John Holahan, Matthew Buettgens, and Stan Dorn The Urban Institute The Kaiser Commission on Medicaid and the Uninsured provides information
More informationDSH Reduction Allocation Process Flows. DRAFT Based on 5/15/13 NPRM
DSH Reduction Allocation Process Flows 1 Overview The ACA mandates that the federal share of DSH payments be reduced by a specified dollar amount for each year between 2014 and 2020. The unreduced federal
More informationJohn Hellow Robert Roth Martin Corry
ohn Hellow Robert Roth Martin Corry Hooper, Lundy and Bookman, P.C. The statements and opinions contained herein represent only the views of ohn R. Hellow Economic Report of The President 2014 2 Components
More informationIntroduction. Incentive Payments for. Health Care Regulatory and Compliance Insights. Daniel F. Gottlieb, Esq.
Health Care Regulatory and Compliance Insights CMS Proposes Medicare and Medicaid Reimbursement Rules for Earning Incentive Payments for Meaningful Use of Certified Electronic Health Record Technology
More information(Cont.) FORM CMS Line 4--Enter the amount of outlier payments made for OPPS services rendered during the cost reporting period. C
03-18 FORM CMS-2552-10 4030.2 4030.2 Part B - Medical and Other Health Services--Use Worksheet E, Part B, to calculate reimbursement settlement for hospitals, subproviders, and SNFs. Use a separate copy
More informationTable 1: Medicaid and CHIP: March and April 2017 Preliminary Monthly Enrollment
Table 1: Medicaid and CHIP: March and April 2017 Preliminary Monthly Enrollment Performance Indicator Information: The Medicaid and CHIP performance indicators were developed in consultation with states,
More informationDecember 15, 2017 (31 State SPAs)
New State SPAs Reimburse 340B Covered Entities at Actual Acquisition Cost: Creates Disincentives For 340B Entities to Choose the Lowest Cost Drugs December 15, 2017 (31 State SPAs) On January 21, 2016,
More informationKey Medicaid Financing Changes in Repeal and Replace Legislation
Key Medicaid Financing Changes in Repeal and Replace Legislation Medicaid and More Alliance for Health Policy July 7, 2017 Overview of Better Care Reconciliation Act (BCRA) Key Changes to Medicaid 2 Like
More informationSouth Carolina Medicaid Disproportionate Share Reimbursement Summit March 21, 2018
South Carolina Medicaid Disproportionate Share 2018 Reimbursement Summit March 21, 2018 Agenda Federal DSH Policy SC DSH Policy DSH Distributions DSH Audit Guidelines Affordable Care Act Federal DSH Policy
More informationH.R. 2: the Medicare Access and CHIP Reauthorization Act of Summary
H.R. 2: the Medicare Access and CHIP Reauthorization Act of 2015 Summary H.R. 2 (P.L. 114-10) became law on April 16, 2015. The law repeals and replaces the Medicare Sustainable Growth Rate (SGR) formula
More informationC o s t R e p o r t i n g : M e d i c a r e C o s t R e p o r t M o r e t h a n j u s t C o m p l i a n c e J u l y 1 8,
Cost Reporting 201: M edicare Cost Report More than just Compliance July 18, 2016 Wipfli LLP Wipfli LLP Agenda What will be covered today: Uses of information included in the Medicare Cost Report for a
More informationMedicare. If you have any other questions, please feel free to call us at MEDICARE ( ). Sincerely,
Medicare Beneficiary Services:1-800-MEDICARE (1-800-633-4227) TTY/ TDD:1-877-486-2048 Thank you for your recent request for the Patient s Request for Medical Payment form (CMS- 1490S). Enclosed is the
More informationkaiser medicaid and the uninsured commission on The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis
kaiser commission on medicaid and the uninsured The Cost and Coverage Implications of the ACA Expansion: National and State-by-State Analysis Executive Summary John Holahan, Matthew Buettgens, Caitlin
More informationNew ZPIC Medicare Audits: Are You Ready? Preparing for Heightened CMS Enforcement Against Fraud and Abuse
presents New ZPIC Medicare Audits: Are You Ready? Preparing for Heightened CMS Enforcement Against Fraud and Abuse A Live 90-Minute Teleconference/Webinar with Interactive Q&A Today's panel features: Sara
More informationMedicare. If you have any other questions, please feel free to call us at MEDICARE ( ). Sincerely,
Medicare Beneficiary Services:1-800-MEDICARE (1-800-633-4227) TTY/ TDD:1-877-486-2048 Thank you for your recent request for the Patient s Request for Medical Payment form (CMS-1490S). Enclosed is the form,
More informationForward-Looking Statements
Forward-Looking Statements The information contained in this presentation includes certain estimates, projections and other forward-looking information that reflect HealthSouth s current outlook, views
More informationThe Medicare Review Process February 25, 2015
WELCOME TO REVENUE CYCLE BASICS: The Medicare Review Process February 25, 2015 Greg Beech Senior Revenue Cycle Analyst esolutions, Inc. 02 Objectives 1 2 3 4 5 Identify Five Common Sources of Claim Reviews
More information2018 TOP POOL EXECUTIVE COMPENSATION & BENEFITS ANALYSIS REDACTED: Data provided to participating pools
2018 TOP POOL EXECUTIVE COMPENSATION & BENEFITS ANALYSIS TABLE OF CONTENTS Introduction............................. 3 Anticipated retirement of top executives............. 4 Salary findings...........................
More informationForm CMS Update Transmittals 20 and 21
Form CMS-2552 2552-96 Update Transmittals 20 and 21 Don Fry, Director, KPMG LLP, Los Angeles, CA Joe Sellars, Director, KPMG LLP, Jacksonville, FL New York ICR Road Shows April 12-16, 2010 Summary of effective
More informationAge of Insured Discount
A discount may apply based on the age of the insured. The age of each insured shall be calculated as the policyholder s age as of the last day of the calendar year. The age of the named insured in the
More informationmedicaid a n d t h e How will the Medicaid Expansion for Adults Impact Eligibility and Coverage? Key Findings in Brief
on medicaid a n d t h e uninsured July 2012 How will the Medicaid Expansion for Adults Impact Eligibility and Coverage? Key Findings in Brief Effective January 2014, the ACA establishes a new minimum Medicaid
More informationState, Local and Net Tuition Revenue Supporting General Operating Expenses of Higher Education, U.S., Fiscal Year 2010, Current (unadjusted) Dollars
State, Local and Net Tuition Revenue Supporting General Operating Expenses of Higher Education, U.S., Fiscal Year 2010, Current (unadjusted) Dollars Net Tuition $51.3 Billion 37% All State Support $73.7
More informationDraft Recommendations on the Update Factors for FY 2017
Draft Recommendations on the Update Factors for FY 2017 May 2, 2016 Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, Maryland 21215 (410) 764-2605 FAX: (410) 358-6217 This document
More informationHow is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured How is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options May 2012 One primary goal of
More information2018 Medicare Fee-For-Service Prospective Payment Systems (As of 2/2/2018)
2018 Fee-For-Service Prospective Systems Capital s Year Oct-Sept Oct-Sept Jan-Dec Jan-Dec Oct-Sept: cost- year Rehab. Hospice DME Services for Jan-Dec Oct-Sept Oct-Sept Oct-Sept Jan-Dec Oct-Sept Oct-Sept
More informationAHLA. LL. PRRB Appeals The View from the Board
AHLA LL. PRRB Appeals The View from the Board Michael W. Harty Chairman PRRB Board Member, Office of Hearings/PRRB Centers for Medicare and Medicaid Services Windsor Mill, MD Institute on Medicare and
More informationFY 2015 Inpatient PPS Proposed Rule: What You Need to Know. June 18, 2014
FY 2015 Inpatient PPS Proposed Rule: What You Need to Know June 18, 2014 IPPS Proposed Rule FY15 Issued April 30 Comments due June 30 Expect final rule by August 1 Key issues: Payment update Medicare DSH
More informationMedicaid & CHIP: December 2014 Monthly Applications, Eligibility Determinations and Enrollment Report February 23, 2015
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Medicaid & CHIP: December 2014 Monthly Applications,
More informationMedicare DSH Dissecting Uncompensated Care Cost
Medicare DSH Dissecting Uncompensated Care Cost September 17, 2018 Northern California HFMA HEALTHCARE: A Brave New World Annual Fall Conference Uncompensated Care Recognition Services 1 Uncompensated
More informationIMPLEMENTATION OF THE AFFORDABLE CARE ACT. August 29, 2012
IMPLEMENTATION OF THE AFFORDABLE CARE ACT August 29, 2012 2 THE MOVING PARTS: Caseload growth without the impact of ACA; Impact on the state s uninsured population; FMAP vs. state share (Regular FMAP,
More informationNorth Shore-Long Island Jewish Health System, Inc. (North Shore-LIJ)
North Shore-Long Island Jewish Health System, Inc. (North Shore-LIJ) ANNUAL FINANCIAL INFORMATION AND OPERATING DATA FOR THE YEAR ENDED DECEMBER 31, 2013 Contents Management s Discussion and Analysis of
More informationkaiser medicaid and the uninsured commission on Medicaid s Role for Dual Eligible Beneficiaries April 2012
I S S U E P A P E R kaiser commission on medicaid and the uninsured Medicaid s Role for Dual Eligible Beneficiaries April 2012 by Katherine Young, Rachel Garfield, MaryBeth Musumeci, Lisa Clemans-Cope,
More informationUpdate on the Medicare and Medicaid Meaningful Use Programs
Update on the Medicare and Medicaid Meaningful Use Programs ACC Quick Hits December 2, 2014 Rick Rifenbark Foley & Lardner LLP rrifenbark@foley.com 213-972-4813 Attorney Advertising Prior results do not
More informationPotential Federal and State-by-State Savings if Medicaid Pharmacy Programs were Optimally Managed
Potential Federal and State-by-State Savings if Medicaid Pharmacy Programs were Optimally Managed February 2011 Commissioned by the Pharmaceutical Care Management Association Prepared by: Joel Menges Shirley
More informationW O R K S H E E T S - 10: K E Y P O I N T S A N D C O N S I D E R AT I O N S F O R C A L C U L AT I N G H O S P I TA L U N C O M P E N S AT E D C A R
W O R K S H E E T S - 10: K E Y P O I N T S A N D C O N S I D E R AT I O N S F O R C A L C U L AT I N G H O S P I TA L U N C O M P E N S AT E D C A R E OUTLINE Overview of FY 2019 IPPS Final Rule Uncompensated
More informationCritical Access Hospital 2012 Financial Leadership Summit
Critical Access Hospital 2012 Financial Leadership Summit Minneapolis, Minnesota June 7-8, 2012 This is a publication of the Technical Assistance and Services Center (TASC), a program of the National Rural
More informationUpdate: 50-State Survey of Retiree Health Care Liabilities Most recent data show changes to benefits, funding policies could help manage rising costs
A fact sheet from Dec 2018 Update: 50-State Survey of Retiree Health Care Liabilities Most recent data show changes to benefits, funding policies could help manage rising costs Getty Images Overview States
More informationFinal Rule Summary. Medicare Inpatient Prospective Payment System Federal Fiscal Year 2015
Final Rule Summary Medicare Inpatient Prospective Payment System Federal Fiscal Year 2015 August 2014 Table of Contents Overview and Resources 1 IPPS Payment Rates 2 Effect of the IQR and EHR Incentive
More informationHow Does the Tax Burden of New Mexico Compare?
November, 2006 How Does the Tax Burden of New Compare? Background One way of assessing the extent to which a state is being taxed too much or too little is by comparing that state with others, or with
More informationELIMINATION OF MEDICARE S WAITING PERIOD FOR SERIOUSLY DISABLED ADULTS: IMPACT ON COVERAGE AND COSTS APPENDIX
ELIMINATION OF MEDICARE S WAITING PERIOD FOR SERIOUSLY DISABLED ADULTS: IMPACT ON COVERAGE AND COSTS APPENDIX ESTIMATING THE FISCAL IMPACTS ON MEDICAID AND MEDICARE FROM ELIMINATING THE WAITING PERIOD:
More informationMEDICARE COST REPORT 101 OCTOBER
MEDICARE COST REPORT 101 OCTOBER 24, 2018 1 PRESENTERS JULIANNE KIPPLE HEALTHCARE DIRECTOR 402.827.2075 JKIPPLE@LUTZ.US KIRK DELPERDANG HEALTHCARE MANAGER 402.827.2361 KDELPERDANG@LUTZ.US AGENDA CMS REIMBURSEMENT
More informationMedicare Audit and Appeals: Practical Advice on Preparing for and Responding to RAC, ZPIC, and MAC Audits. February Overview
Medicare Audit and Appeals: Practical Advice on Preparing for and Responding to RAC, ZPIC, and MAC Audits February 2012 B. Scott McBride Baker & Hostetler LLP smcbride@bakerlaw.com Anna M. Grizzle Bass,
More informationHospital Cost Report Training Level II Critical Reimbursement Strategies // General Session Dallas - Hilton Dallas/Southlake Town Square
Hospital Cost Report Training Level II Critical Reimbursement Strategies // General Session Dallas - Hilton Dallas/Southlake Town Square JULY 27-28, 2016 All information provided is of a general nature
More informationReimbursement and Funding Methodology. Florida Medicaid Reform Section 1115 Waiver. Low Income Pool
Reimbursement and Funding Methodology Florida Medicaid Reform Section 1115 Waiver Low Income Pool Submitted June 26, 2009 1 Table of Contents I. OVERVIEW... 3 II. REIMBURSEMENT METHODOLOGY... 5 III. DEFINITIONS...
More informationTable 1: Medicaid and CHIP: June and July 2017 Preliminary Monthly Enrollment
Table 1: Medicaid and CHIP: June and July 2017 Preliminary Monthly Enrollment Performance Indicator Information: The Medicaid and CHIP performance indicators were developed in consultation with states,
More informationACORD Forms Updated in AMS R1
ACORD Forms Updated in AMS360 2017 R1 The following forms will use the ACORD form viewer, also new in this release. Forms with an indicate they were added because of requests in the Product Enhancement
More information