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.
We are now in the midst of Federal fiscal year (FFY) 2020 which began at the start of this month. A new Federal fiscal year brings with it new standardized rates that affect hospital discharges on or after October 1, 2019. Each year, CMS publishes updates to the regulations for inflation factors, wage adjustments, etc., which for the current FFY, can be found in the 2020 Inpatient Acute (IPPS) final rule on the CMS website. It is important to note that CMS published a correction notice on October 8, 2019, in which standardized rate values were revised and now differ from what was published in the August version of the final rule.
In Texas, hospitals must apply and ultimately qualify for payment to participate in the Disproportionate Share Hospital (DSH) and Uncompensated Care Section 1115 waiver (UC) programs. Texas hospitals that wish to participate in either the FFY 2020 DSH and/or the demonstration year (DY) 9 UC must request an application to apply from HHSC and the online application request form must be submitted no later than 5 pm, Friday, September 20, 2019. Failure to apply by the deadline will result in the hospital not being able to participate in these Texas Medicaid Supplemental Payment Programs and loss of appeal rights to a non-qualification decision.
Hospital providers from all over the country converged at this year’s Health Financial Systems User Meeting in hopes to hear updates on the latest issues affecting Medicare reimbursement. This year’s two-day meeting curated twenty-three different presentations ranging from Medicare cost report form changes to software reviews and Medicare information updates. We could write for days on all of the information we absorbed at this year’s assembly, but after reviewing our catalog of notes and identifying the recurring themes across presentations, we’ve compiled our top four takeaways we think hospital providers should be aware of to improve their reimbursement areas, their cost reports and maintain compliance with Medicare regulations.
The 2020 Inpatient Skilled Nursing Facility Final Rule was published in the Federal Register August 7, 2019. The rule can be found through the CMS website or you can view the Federal Register version here. This SNF rule affects discharges on or after October 1, 2019.
The 2020 Inpatient Rehab Final Rule was published in the Federal Register August 8, 2019, and will affect discharges on or after October 1, 2019. The 2020 Rehab (IRF) Final Rule can be viewed here.
Each year, CMS publishes updates to the regulations for inflation factors, wage adjustments, etc. and for FFY 2020, CMS has finalized the following updates to the Rehab rates:
The FY 2020 Inpatient Psych Final Rule was put on display for public inspection on July 30, 2019, and was published in the Federal Register August 6, 2019. The FY 2020 Psych Final Rule can be viewed here. As a reminder, this IPF rule affects discharges on or after October 1, 2019.
The FY 2020 Inpatient Prospective Payment System (IPPS) Final Rule was put on display for public inspection on August 2, 2019, and is scheduled to be published in the Federal Register on August 16, 2019. The pre-publication version can be viewed HERE or on the FY 2020 IPPS Final Rule homepage. These changes will go into effect October 1, 2019.
The 2020 IPPS Proposed Rule was put on display for public inspection on April 23, 2019, and subsequently published in the Federal Register May 3, 2019. You can view the rule in its entirety here. If finalized, the proposed 2020 IPPS rule will affect discharges on or after October 1, 2019. Each year, CMS publishes updates to the regulations for inflation factors, wage adjustments, etc. The rates that are reviewed in this post are the non-wage index adjusted rates for specific Core-Based Statistical Areas (CBSAs) as well as other updates made to the standardized rates.
The FY 2020 Hospice 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 on April 25, 2019. In the meantime, the pre-publication version can be viewed here. If finalized, this Hospice proposed rule will be effective October 1, 2019.
Each year, CMS publishes updates to the regulations for inflation factors, wage adjustments, etc. For FY 2020, CMS has proposed the following updates to the Medicare Hospice payment rates: