In our realm of Medicare provider reimbursement, Worksheet S-10 has been the hot topic of late. It has certainly been a heavy focus for our last few webinars and blog posts and while Worksheet S-10 has captured the provider reimbursement community's attention, it is important not to lose sight of the Medicare Disproportionate Share Hospital (DSH) program. Now, the affordable care act initially changed the Medicare DSH calculation (hence the S-10 popularity), but there have been additional changes enacted in recent rounds of rule making that hospitals should be aware of when it comes to DSH. For this reason alone, we thought that it’s a perfect time to revisit the Medicare DSH calculation starting with a basic 101 and then expand on the changes in future posts.
As you will recall from the FY 2019 IPPS final rule-making cycle, CMS issued new requirements for supporting documentation that must be submitted along with the Medicare cost report. While that final rule was posted a little over a year ago, hospitals will soon be in the midst of filing the first affected cost reports. The new Medicare cost report supporting documentation is required for cost reporting periods beginning on or after October 1, 2018.
CMS posted the FFY 2017 SSI ratios to their website. The FFY 2017 SSI ratio file (DSH Adjustment and 2016-2017 File [ZIP, 246KB]) can be found in the Downloads section of CMS' Disproportionate Share Hospital (DSH) webpage or by following the link below:
The 2019 IPPS Final Rule was put on display for public inspection on August 2, 2018 and is scheduled to be published in the Federal Register on Monday, August 17, 2018. The pre-publication version can be viewed HERE (Medicare DSH begins on page 969). SCA will be reviewing and analyzing the details of the final rule and its components and we will provide more detailed conclusions soon.
The 2019 IPPS Proposed Rule will be published in the Federal Register on May 7, 2018. If finalized, these changes will go into effect October 1, 2018. The pre-published version can be viewed HERE. Public comments will be accepted until 5 p.m. EDT on June 25, 2018. Below is SCA’s "as brief as we could make it", yet comprehensive summary on the Medicare DSH/Uncompensated Care payment portion (pages 818-877) of the proposed rule as it will affect qualifying DSH hospitals.
The 2019 IPPS Proposed Rule was put on display for public inspection on April 24, 2018 and is scheduled to be published in the Federal Register on Monday, May 7, 2018. The pre-publication version can be viewed HERE. All public comments to the proposed rule are to be received by 5 p.m. EST on Monday, June 25, 2018.
In regards to the Medicare DSH/UC payment, Worksheet S-10 will be used to calculated two-thirds of a qualifying provider's Factor 3. SCA will be reviewing and analyzing the full details of the proposed rule and its components, and we will provide our conclusions in the coming week.
CMS just posted the FFY 2016 SSI ratios to their website. The FFY 2016 SSI ratio file (DSH Adjustment and 2015-2016 File [ZIP, 248KB]) can be found in the Downloads section of CMS' Disproportionate Share Hospital (DSH) webpage or by following the link below:
It is fitting that the month of Thanksgiving also begins the 4th year of SCA's healthcare blog. We thank you, the readers, for being a part of our story as we share the latest in Medicare DSH reimbursement, Worksheet S-10 uncompensated care and 340B drug pricing program news. You trust us with your time, and we appreciate being a source of insight in this ever-changing industry. As we celebrate our 3rd anniversary and start to our 4th year, let's take a look at how far we have come, together.
On October 20, 2017, CMS issued another Technical Direction Letter (TDL) extending the deadline for all IPPS hospitals to submit revised or initial FFY 2014 and 2015 Worksheet S-10’s to January 2, 2018. Southwest Consulting Associates confirmed this directly with CMS' Division of Acute Care and is monitoring the CMS website for a posted notice, which CMS also stated would be available shortly. Until the official notice is posted, please contact your MAC for additional information.
Last week, September 29, 2017, CMS issued Transmittal 11 that makes a number of revisions to the instructions for reporting data on cost report Worksheet S-10. These instructions need to be incorporated into any FFY 2014 & FFY 2015 Worksheet S-10 revisions providers are working to submit by the October 31, 2017 deadline and then for any future year submissions. In particular, the changes include: