2016 ICR Changes and Filing Procedures. Form CMS Transmittals #7 and #8. Demonstration of Software Enhancements

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1 2016 ICR Changes and Filing Procedures Form CMS Transmittals #7 and #8 Demonstration of Software Enhancements NYSICR Road Shows April 11-15, 2016 Joe Sellars, Director, KPMG LLP, Jacksonville, Florida Don Fry, Director, KPMG LLP, Los Angeles, California

2 Today s Agenda This year s TOP TEN 2016 NYSDOH changes to the ICR, filing procedures and reminders Further extension of MDH Status and Low Volume Adjustment Refresher of most significant changes in Form CMS Transmittal #7 Review of significant changes in Form CMS Transmittal #8 Review of using the KPMG Compu-Max website to obtain software updates ICR software enhancements Q&A 2

3 2016 NYSDOH ICR CHANGES The only change to the ICR for reporting year 2015 is the addition of line 072 on Exhibit 50, a Yes/No question for the Patient Financial Assistance Asset Test Survey: Appearance of Exhibit 50, Line 072 in the ICR software: For cost reporting periods ending on and after June 30,

4 OBTAINING UPDATED SOFTWARE AND SUPPORT The software continues to be available for download from the KPMG Compu-Max website: o o USERNAME: nyicruser o PASSWORD: 2015 New address for ICR problem resolution and questions: o Hospital.ICR@health.ny.gov o For problem resolution, send your four-pack files (CR, IC, B_, T_) to this address. The files will then be forwarded to KPMG for follow-up if necessary. 4

5 FILING PROCEDURES o DH file (HCS electronic submission) - Due Date : Tuesday, May 31, 2016 o Due within 5 Business days of electronic submission: o Signed CEO Certification o Edit Report (Initialed with explanations) o Audited Financial Statements 5

6 FILING PROCEDURES o Signed CFO/CEO Certification: file named with 7 digit operating certificate and CFO Example: _CFO o Edit Report (Initialed with explanations) file named with 7 digit operating certificate and Edits Example: _Edits o Audited Financial Statements file named with 7 digit operating certificate and AFS Example: _AFS 6

7 FURTHER EXTENSION OF MEDICARE DEPENDENT HOSPITAL PROGRAM AND LOW VOLUME ADJUSTMENT The Medicare Dependent Hospital (MDH) program has been extended through September 30, The MDH program had initially been set to end as of September 30, 2013, then it was extended to March 31, The Low Volume Adjustment that was initially effective (for eligible hospitals) for discharges occurring on and after October 1, 2010, has been extended through September 30, The Low Volume Adjustment had initially been set to end as of September 30, 2013, then it was extended to March 31, Both of these changes are part of the Medicare Access and CHIP (Children s Health Insurance Program) Reauthorization Act of 2015, Sections 204 (LVA) and 205 (MDH) 7

8 Refresher of Most Significant Transmittal #7 Changes NOTE: This section addresses the most significant changes in Form CMS Transmittal #7. It should not be considered a substitute for reviewing the actual instructions and forms as issued by CMS, accessible via the NYSICR software s Help file. Form CMS Transmittal #7 became effective for cost reporting periods ending on and after October 1, CMS changes to the forms and instructions are noted in red, italicized text. 8

9 Worksheet S-2 Part I, Lines 40 and 171 Line 40--Section 3008 of the ACA 2010 established the Hospital Acquired Condition (HAC) Reduction Program, beginning in FFY Enter in column 1, Y for yes or N for no if your hospital is subject to the HAC reduction adjustment for discharges occurring prior to October 1. For cost reporting periods that overlap October 1, 2014, enter N in column 1. Enter in column 2, Y for yes or N for no if your hospital is subject to the HAC reduction adjustment for discharges occurring on or after October 1. Triggers completion of Exhibit 5 (for E Part A) Line 171--If this provider is a meaningful EHR technology user (line 167 is Y ), the days associated with individuals enrolled in section 1876 Medicare cost plans must be included in the calculation of the incentive payment. Indicate if you have section 1876 days included in the days reported on Worksheet S-3, Part I, line 2, column 6, by entering Y for yes and N for no. 9

10 Worksheet E Part A, Lines 1, 1.01 and 1.02 Line 1--The amount entered on this line is the sum of the federal specific operating portion (DRG payments) paid for PPS discharges during the cost reporting period and the DRG payments made for PPS transfers during the cost reporting period. For cost reporting periods overlapping October 1, 2013 and subsequent years, do not complete line 1, but complete lines 1.01 and Line For cost reporting periods that overlap October 1, 2013 and subsequent years, enter the amount of the federal specific operating portion (DRG payments) paid for PPS discharges and transfers occurring prior to October 1. For example, a calendar year provider would include DRG payments for discharges occurring during the period of (January 1 through September 30). Line For cost reporting periods that begin or overlap October 1, 2013 and subsequent years, enter the amount of the federal specific operating portion (DRG payments) paid for PPS discharges and transfers occurring on or after October 1. For example, a calendar year provider would include DRG payments for discharges occurring during the period of (October 1 through December 31). 10

11 Worksheet E Part A, Lines 1.03 and 1.04 Line Enter the amount of the federal specific operating portion (DRG payments) for Model 4 bundled payments for care improvement (BPCI) initiative, effective for discharges occurring on or after October 1, Effective for cost reporting periods that overlap October 1, 2014 and subsequent years, enter the amount of the federal specific operating portion (DRG payments) paid for Model 4 BPCI discharges and transfers occurring prior to October 1. Line Effective for cost reporting periods that begin or overlap October 1, 2014 and subsequent years, enter the amount of the federal specific operating portion (DRG payments) paid for Model 4 BPCI discharges and transfers occurring on or after October 1. 11

12 SEPARATION OF IME FOR MANAGED CARE (E Part A, Lines 22.01, and 29.01) Line 22--For cost reporting periods beginning before October 1, 2014, calculate the IME payment adjustment as follows: Multiply the appropriate multiplier of the adjustment factor (currently 1.35) times {((1 + line 21) to the.405 power) - 1} times {the sum of lines 1, 1.01, 1.02, 1.03, 1.04, and 3}. Effective for cost reporting periods beginning on or after October 1, 2014, calculate the IME payment adjustment as follows: Multiply the appropriate multiplier of the adjustment factor (currently 1.35) times {((1 + line 21) to the.405 power) - 1} times {the sum of lines 1.01, 1.02, 1.03, and 1.04}. Line Effective for cost reporting periods beginning on or after October 1, 2014, calculate the IME payment adjustment for managed care, as follows: Multiply the appropriate multiplier of the adjustment factor (currently 1.35) times {((1 + line 21) to the.405 power) - 1} times line 3. 12

13 SEPARATION OF IME FOR MANAGED CARE (E Part A, Lines 22.01, and 29.01) Line 28--IME Add On Adjustment--For cost reporting periods beginning before October 1, 2014, enter the sum of lines 1, 1.01, 1.02, 1.03, 1.04, and 3, multiplied by the factor on line 27. Effective for cost reporting periods beginning on or after October 1, 2014, calculate the IME add-on adjustment as follows: Enter the sum of lines 1.01, 1.02, 1.03, and 1.04, multiplied by the factor on line 27. Line IME Add On Adjustment - Managed Care--Effective for cost reporting periods beginning on or after October 1, 2014, enter the result of line 3, multiplied by the factor on line

14 SEPARATION OF IME FOR MANAGED CARE (E Part A, Lines 22.01, and 29.01) Line 29--Total IME Payment--Enter the sum of lines 22 and 28. Line Total IME Payment - Managed Care--Effective for cost reporting periods beginning on or after October 1, 2014, enter the sum of lines and This also resulted in a change to the instructions for E Part A, Line 49: Line 49--For SCHs, enter the greater of line 47 or 48, plus the amount from line For MDH discharges occurring on or after October 1, 2006, and before April 1, 2015, if line 47 is greater than line 48, enter the amount on line 47, plus the amount from line For MDHs if line 48 is greater than line 47, enter the amount on line 47, plus 75 percent of the amount that line 48 exceeds line 47, plus the amount from line Hospitals not qualifying as SCH or MDH providers will enter the amount from line 47, plus the amount from line

15 DSH CALCULATION CHANGES (E Part A, Line 34) Line 34--Multiply line 33 by line 1 for cost reporting periods ending on or before September 30, Effective for cost reporting periods that overlap October 1, 2013, enter the sum of {(line 33 times line 1.01), plus ((line 33 times the sum of lines 1.02 and 1.03) times 25 percent)}. For cost reporting periods beginning on or after October 1, 2013, multiply (line 33 times the sum of lines 1.01 through 1.03) times 25 percent. For cost reporting periods that overlap or begin on or after October 1, 2014, enter the sum of {((line 33 times the sum of lines 1.01 and 1.03) times 25 percent), plus ((line 33 times the sum of lines 1.02 and 1.04) times 25 percent)}. 15

16 NEW OTHER ADJUSTMENT LINES (E Part A Lines 70.89, and 70.91) Line Enter the Pioneer Accountable Care Organization (ACO) demonstration payment adjustment amount in accordance with ACA 2010, 3022 effective for discharges occurring on or after April 1, Obtain this amount from the PS&R. Line For MDH use only. Enter the hospital value-based purchasing (HVBP) adjustment amount relative to the HSP bonus payment from line 102, sum of columns 1 and 2. Line For MDH use only. Enter the hospital readmission reduction (HRR) adjustment amount relative to the HSP bonus payment from line 104, columns 1 and 2. 16

17 NEW OTHER ADJUSTMENT LINES (E Part A Line and impact on Line 71) Line Enter the HAC program payment reduction adjustment amount effective for discharges occurring on or after October 1, Use Exhibit 5 or similar worksheet to reconcile the HAC payment adjustment amount. Line 71--Enter the result of line 67 plus or minus lines 69, 70.90, 70.91, 70.93, 70.94, 70.96, 70.97, 70.98, and line 70 and its subscripts not previously identified, minus lines 68, 70.89, and

18 MEDICARE DEPENDENT HOSPITALS HVBP AND HRR ADJUSTMENTS FOR HSP BONUS PAYMENT (E Part A Lines ) Hospital Specific Payment (HSP) Bonus Payment HVBP Adjustment and HRR Adjustment--The ACA and 3025 implemented HVBP and HRR and applied special rules for MDHs through FFY13. Effective for discharges occurring on or after October 1, 2013, MDHs that receive a HSP bonus payment on the cost report are subject to a HVBP and HRR adjustment for that bonus payment amount. The HSP bonus payment amount is 75 percent of the amount that line 48 exceeds line 47. Complete lines 100 through 104 only when line 48 exceeds line 47. NOTE: For cost reporting periods that overlap October 1, 2013, leave column 1 blank and complete only column 2. For cost reporting periods that begin on October 1, complete only column 2. 18

19 MEDICARE DEPENDENT HOSPITALS HVBP AND HRR ADJUSTMENTS FOR HSP BONUS PAYMENT (E Part A Lines ) (continued) Line 100--If line 48 is greater than line 47, enter the pro rata share of the HSP bonus payment amount in columns 1 and 2. Enter in column 1, {((line 48 minus line 47) times 75 percent) times (the number of days in the cost reporting period prior to October 1 divided by the total days in the cost reporting period)}. Enter in column 2, {((line 48 minus line 47) times 75 percent) times (the number of days in the cost reporting period on or after October 1 divided by the total days in the cost reporting period)}. If the hospital does not have MDH status for the entire cost reporting period, prorate accordingly. 19

20 MEDICARE DEPENDENT HOSPITALS HVBP AND HRR ADJUSTMENTS FOR HSP BONUS PAYMENT (E Part A Lines ) (continued) Line 101--Enter the HVBP adjustment factor that corresponds to the portion of the cost reporting period prior to October 1 in column 1 and the HVBP adjustment factor that corresponds to the portion of the cost reporting period on or after October 1 in column 2. The HVBP adjustment factors are published annually in the IPPS final rule and posted on the CMS website NOTE: A factor less than 1 will result in a negative adjustment A factor greater than 1 will result in a positive adjustment A factor equal to 1 will result in no adjustment Line 102--The HVBP adjustment amount is computed as ((HSP Bonus x HVBP adjustment factor) minus HSP Bonus). Enter in column 1, the HVBP adjustment amount for the portion of the cost reporting period prior to October 1 by multiplying( column 1, line 100, times column 1, line 101), minus column 1, line 100. Enter in column 2, the HVBP adjustment amount for the portion of the cost reporting period on or after October 1 by multiplying (column 2, line 100 times column 2, line 101) minus column 2, line

21 MEDICARE DEPENDENT HOSPITALS HVBP AND HRR ADJUSTMENTS FOR HSP BONUS PAYMENT (E Part A Lines ) (continued) Line 103--Enter the HRR adjustment factor that corresponds to the portion of the cost reporting period prior to October 1 in column 1, and HRR adjustment factor that corresponds to the portion of the cost reporting period on or after October 1 in column 2. The HRR adjustment factors are published annually in the IPPS final rule and posted on the CMS website NOTE: A factor less than 1 will result in a negative adjustment A factor greater than 1 will result in a positive adjustment A factor equal to 1 will result in no adjustment Line 104--The HRR adjustment amount is computed as ((HSP Bonus x HRR adjustment factor) minus HSP Bonus). Enter in column 1, the HRR adjustment amount for the portion of the cost reporting period prior to October 1 by multiplying (column 1, line 100 times column 1, line 103) minus column 1, line 100. Enter in column 2, the HRR adjustment amount for the portion of the cost reporting period on or after October 1 by multiplying (column 2, line 100 times column 2, line 103) minus column 2, line

22 EXHIBIT 4 LOW VOLUME ADJUSTMENT CALCULATION Exhibit 4 was modified to accommodate changes made to corresponding lines on Worksheet E Part A. The following lines were also added: Line (Corresponds to Worksheet E, Part A, line 55)--For discharges on or after October 1, 2014, prorate in columns 2 through 4, the amount reported on Worksheet E, Part A, line 55, net organ acquisition costs, based on the ratio of days in each applicable period to total days in the cost reporting period. The sum of columns 2 through 4 must equal the amount reported on Worksheet E, Part A, line 55. Line (Corresponds to Worksheet E, Part A, line 68)--For discharges on or after October 1, 2014, enter the credits for replaced devices. The PS&R information must be split and reported in columns 2 through 4 and must concur with the PS&R paid through date used to calculate the cost report. 22

23 EXHIBIT 4 LOW VOLUME ADJUSTMENT CALCULATION 23

24 EXHIBIT 5 HOSPITAL ACQUIRED CONDITIONS ADJUSTMENT CALCULATION Instructions for Completing Exhibit 5-- Adjustment to Hospital Payments for Hospital Acquired Conditions (HAC) Calculation Schedule: Section 3008 of ACA 2010 establishes the HAC Reduction Program, beginning in FFY 2015 (discharges occurring on or after October 1, 2014), for IPPS hospitals to improve patient safety. HACs are medical errors or serious infections that patients contract while in the hospital. Under the HAC Reduction Program, a 1 percent payment reduction applies to a hospital whose ranking is in the top quartile (25 percent) of all applicable hospitals, relative to the national average, of HACs acquired during the applicable period, and applies to all of the hospital s discharges for the specific fiscal year. For SCHs and MDHs, the HAC reduction percentage applies to either the federal payment rate or the HSP rate, whichever results in a greater operating IPPS payment. See 2015 IPPS final rule (79 FR (August 22, 2014)). A response of Y in either column of Worksheet S-2 Part I, Line 40 triggers the completion of Exhibit 5. 24

25 EXHIBIT 5 HOSPITAL ACQUIRED CONDITIONS ADJUSTMENT CALCULATION 25

26 Review of Significant Transmittal #8 Changes NOTE: This document addresses the most significant changes in Form CMS Transmittal #8. It should not be considered a substitute for reviewing the actual instructions and forms issued by CMS, accessible via the NYSICR software s Help file. Form CMS Transmittal #8 became effective for cost reporting periods ending on and after June 30, CMS changes to the forms and instructions are noted in red, italicized text. Black, italicized text is used when an entire page contains new or changed instructions. 26

27 Worksheet S-2 Part I, Line Instructions for cost reporting periods that overlap two Federal Fiscal Years Line For cost reporting periods that overlap or begin on or after October 1, 2013, did this hospital receive interim uncompensated care payments? Enter in column 1, Y for yes or N for no, for the portion of the cost reporting period prior to October 1. Enter in column 2, Y for yes or N for no, for the portion of the cost reporting period beginning on or after October 1. For cost reporting periods that begin on October 1, enter N for no in column 1 and complete column 2; however, when the cost reporting period begins on October 1 and overlaps October 1 of the subsequent year, complete column 1 for the first period (October 1 through September 30) and complete column 2 for the remainder of the cost reporting period. 27

28 Worksheet S-2 Part I, Line 87 and Line 145, Column 2 Line 87--Is this hospital a LTCH classified under section 1886(d)(1)(B)(iv)(II) (referred to as subclause (II) LTCHs)? Enter "Y" for yes or "N" for no. Affected providers will be reimbursed under TEFRA (Worksheet E-3 Part I) instead of LTCH PPS (Worksheet E-3 Part IV) According to CMS, there is only one such provider in existence, but that number is expected to increase Line 145--If costs for renal dialysis services are claimed on Worksheet A, line 74, are the costs for inpatient services only? Enter Y for yes or N for no in column 1. If column 1 is no, does the dialysis facility include Medicare utilization for this cost reporting period? Enter Y for yes or N for no in column 2. If column 1 is yes or column 2 is no, do not complete Worksheet S-5 or the Worksheet I series for renal dialysis services. N in Column 2 disables Level I edits for the I-series worksheets. This addresses situations where providers have renal dialysis costs but no Medicare utilization. 28

29 Worksheet S-2 Part I, Line 167 Line 167--Is this hospital/campus a meaningful user of electronic health record (EHR) technology in accordance 1886(n) of the Social Security Act as amended by the section 4102 of the American Recovery and Reinvestment Act (ARRA) of 2009? Enter Y for yes or N for no. A CAH that is not a meaningful user beginning in FFY 2015 is subject to a payment adjustment as defined in 42 CFR (a)(6)(i). A CAH may, on a case-by-case basis, be granted an exception from this adjustment if CMS or its Medicare contractor determines, on an annual basis, that a significant hardship exists, such as in the case of a CAH in a rural area without sufficient internet access. However, in no case may a CAH be granted an exception for more than 5 years. 29

30 Worksheet S-2 Part I, Line Line If this provider is a CAH (line 105 is Y ) and is not a meaningful user (line 167 is N ), does this provider qualify for a hardship exception under 42 CFR (a)(6)(ii)? Enter Y for yes or N for no. If no, the CAH is subject to a payment adjustment. The CAH s reasonable costs in providing inpatient services are adjusted as defined in 42 CFR (a)(6)(i) for cost reporting periods that begin in or after FFY Specifically, sections 1814(l)(4)(A) and (B) of the Act provide that, if a CAH does not demonstrate meaningful use of certified EHR technology for an applicable EHR reporting period, then for a cost reporting period beginning in FFY 2015, the CAHs reasonable costs shall be adjusted from 101 percent to percent. For a cost reporting period beginning in FFY 2016, the CAH s reasonable costs shall be adjusted to percent. For a cost reporting period beginning in FFY 2017 and each subsequent FFY, the CAH s reasonable costs shall be adjusted to 100 percent. Affects calculation of Worksheet E-3 Part V for CAHs 30

31 Worksheet S-2 Part I, Line 169 This is not a Transmittal #8 Change. It is expected to appear in Transmittal #9. It is in effect now by mutual agreement between the software vendors. If Worksheet S-2 Part I, Line 167 = "Y" and Line 105 = "N" and the hospital has completed the EHR transition, the cost report preparer is expected to enter 9.99 as the transition factor on Line 169. In the calculation of Worksheet E-1 Part II, the software will treat the 9.99 entry as if it were zero. Prevents the inappropriate occurrence of ECR Edit 10450S 31

32 Worksheet S-3 Part I, IPF/IRF Subprovider Title XIX Managed Care Discharges Columns 12 through 14--Enter the number of discharges including deaths (excluding newborn and DOAs) for each component by program. A patient discharge, including death, is a formal release of a patient. (See 42 CFR ) Enter the title XVIII Medicare Advantage (MA) discharges in column 13, line 2. For cost reporting periods ending on or after June 30, 2014, enter the title XIX managed care discharges in column 14, line 2. For columns 13 and 14, line 2 is a subset of column 15, line 1. For cost reporting periods ending on or after October 1, 2014, enter the title XIX managed care discharges in column 14, lines 3 and 4, for the IPF and IRF subproviders. For column 14, lines 3 and 4 are subsets of column 15, line 16 and 17, respectively. Lines 2 through 4, column 14, are collected for informational purposes only. 32

33 Worksheet A-8-2 RCE Limits Update Column 6--For each line of data, enter the RCE limit applicable to the physician's compensation included in that cost center. Obtain the RCE limit from the applicable chart in the Federal Register as listed below. If the physician specialty is not identified in the chart, use the RCE for the Total category (from the same chart). Cost Reporting Period Beginning on or After Federal Register Note January 1, FR (August 1, 2003) Your location governs which of the three geographical categories are applicable: non-metropolitan areas, metropolitan areas less than one million, or metropolitan areas greater than one million. January 1, FR (August 22, 2014) Not applicable. 33

34 Worksheet D-1 Part II, Lines for subclause (II) LTCHs Lines 54 through 63--Except for those hospitals specified below, all hospitals (and distinct part hospital units) excluded from prospective payment and subclause (II) LTCHs are reimbursed under cost reimbursement principles and are subject to the ceiling on the rate of hospital cost increases (TEFRA). (See 42 CFR ) CAHs do not complete these lines as CAH reimbursement is based on reasonable cost. The following hospitals are reimbursed under special provisions and, therefore, are not generally subject to TEFRA or prospective payment: NOTE: For lines 54 through 63: In the FFY 2015 IPPS final rule, (79 FR (August 22, 2014)), CMS established a payment adjustment under LTCH PPS for hospitals classified under subclause (II) of subsection (d)(1)(b)(iv) of the Act (referred to as subclause (II) LTCHs), effective for cost reporting periods beginning on or after October 1, 2014, (that is, FFY 2015 and subsequent fiscal years). The payment adjustment is determined based on reasonable cost, as described at 42 CFR (c). New providers and subclause (II) LTCHs do not complete lines 58 through

35 Worksheet E Part A, Uncompensated Care Adjustment Instructions for cost reporting periods that overlap two Federal Fiscal Years NOTE: For cost reporting periods that overlap October 1, 2013, leave column 1 blank and complete only column 2. For cost reporting periods that begin on October 1, complete only column 2; however, when the cost reporting period begins on October 1 and overlaps October 1 of the subsequent year, complete column 1 for the first period (October 1 through September 30) and complete column 2 for the remainder of the cost reporting period. The note appears immediately before the instructions for Worksheet E Part A Line 35 35

36 UNCOMPENSATED CARE CALCULATION REMINDERS Worksheet E Part A, Lines 35, 35.01, 35.02, and 36 The Uncompensated Care Adjustment will not be calculated if the Disproportionate Share Adjustment (Lines 30-34) has not been calculated. If the hospital has pre-calculated Uncompensated Care payment amounts listed in the appropriate tables for the Federal Fiscal Years represented by Columns 1 and 2, the payment amounts will appear on Line Lines 35 and are not necessary under those circumstances and they will both equal zero. If the hospital does not have a pre-calculated UCC payment amount in the corresponding table to Column 1 and/or 2, the hospital s Factor 3 ratio from the table will be placed into Line and the total UCC pool amount will be placed into Line 35. Line will equal Line 35 times Line

37 PENALTY FOR CAHs THAT ARE NOT EHR MEANINGFUL USERS (E-3 Part V, Line 6) Line 6--For a new children s or new cancer hospital that is cost reimbursed, enter the result of line 4 minus line 5. For CAHs: For cost reporting periods beginning before October 1, 2014, (multiply the amount on line 4 by 101 percent) minus the amount on line 5. For cost reporting periods beginning in FFY 2015 and subsequent years, if the CAH is a meaningful user, (multiply the amount on line 4 by 101 percent) minus the amount on line 5. If the CAH is not a meaningful user of EHR for cost reporting periods beginning in FFY 2015 and subsequent years, (Worksheet S-2, line 167 is N ) and it does not qualify for a hardship exception (Worksheet S-2, line is N ), calculate line 6 as follows: For cost reporting periods beginning in FFY 2015 (October 1, 2014 through September 30, 2015), (multiply the amount on line 4 by percent) minus the amount on line 5. For cost reporting periods beginning in FFY 2016 (October 1, 2015 through September 30, 2016), (multiply the amount on line 4 by percent) minus the amount on line 5. For cost reporting periods beginning in FFY 2017 and each subsequent fiscal year (cost reporting periods beginning on or after October 1, 2016), (multiply the amount on line 4 by 100 percent) minus the amount on line 5. 37

38 Worksheet L Part I Changes to Capital DSH calculation for geographically redesignated hospitals Lines 1 and 1.01 will be subscripted into Column 1 Urban and Column 1.01 Rural This removes the Capital DRG and Model 4 BPCI Capital DRG amounts from the calculation of Capital DSH for the portion of the cost reporting period that the provider is/was Rural S-2 Part I, Lines 26 and 27 are used to determine Urban / Rural status For cost reporting periods overlapping 10/1/2014 only (see 42 CFR (Special treatment: Hospitals located in areas that are changing from urban to rural as a result of a geographic re-designation)) 38

39 ELIMINATION OF M-SERIES WORKSHEETS FOR HOSPITAL-BASED FEDERALLY QUALIFIED HEALTH CENTERS Worksheet M-1 Instructions This worksheet is for the recording of direct RHC and FQHC costs from your accounting books and records to arrive at the identifiable RHC/FQHC cost. This data is required by 42 CFR The worksheet also provides for the necessary reclassifications and adjustments to certain accounts prior to the cost finding calculations. Effective for cost reporting periods beginning on or after October 1, 2014, FQHCs filing as part of the hospital healthcare complex do not complete the Worksheet M series but complete the new FQHC PPS N series worksheets in Form CMS when they become available. 39

40 Using the KPMG Compu-Max Website Sole means of distributing ICR software Used for initially obtaining software as well as subsequent updates Do not attempt to apply program updates when the ICR software is running at the same time. 40

41 Using the KPMG Compu-Max Website Home Page Click here to access the software download area Do not try to use these links they are not part of the Compu- Max website 41

42 Using the KPMG Compu-Max Website Appearance after Software Updates link has been clicked: Click here to continue to the software download area login page 42

43 Using the KPMG Compu-Max Website Logging In Enter nyicruser as the User Name. Enter 2015 as the Password. 43

44 Using the KPMG Compu-Max Website List of available downloads Click the link for the NYSICR-2011 software to go to its specific download page 44

45 Using the KPMG Compu-Max Website NYSICR Download Page The dates for Download page last updated and software last modified may not always be the same. The software last modified date is the date that the software will display on its start-up screen. The Web Update file updates all files in the application folder only. The Full Setup file contains the SETUP.EXE file to perform a complete installation of the software. 45

46 SOFTWARE ENHANCEMENTS Additional Documents Available via Help Menu In addition to providing access to the software s Help files, CMS and ICR instructions, the Help menu item may also be used to display selected PDFs and text files containing additional information. These include change logs, update documents and Road Show presentation files: 46

47 SOFTWARE DEMONSTRATION Review of Edit Explanation Feature - Enter explanations for level edits only - An ED file is created for keeping the edit explanations - Press the Enter key after entries to be sure they re recognized by the program - Suggestion: Wait until you re ready to submit to enter explanations 47

48 SOFTWARE DEMONSTRATION Review of Enhanced Variance Analysis Feature 48

49 Questions? 49