Docstoc

NYS Institutional Cost Report Seminar

Document Sample
NYS Institutional Cost Report Seminar Powered By Docstoc
					NYS Institutional Cost
  Report Seminar
     HFMA Sessions
    April 4 – 8, 2011
   John W. Gahan, Jr.
      Jane Casale
      Tami Berdi
    Donna Choiniere
                 Objectives:
 Data Integrity
  – Using the report more often
  – Facilities not reporting as accurately as possible
  – Taking away variability/More standardization
  – Use of hardcoded cost centers wherever possible
 Edits
  – New tool to assist hospitals with the accuracy of
    reports prior to submission
 RCC
  – The addition of RCC schedules that will help
    providers better align costs and charges             2
                  Agenda
 2010 Changes
  – Cost Center Matrix
  – Additions/Modifications/Deletions
 Provider Assistance
 Filing Procedures
 Audit vs. Certification
 Questions and Answers

                                        3
       Cost Center Matrix
 Deleted Cost Centers
   – Drug Rehab - 204
   – Drug Detox - 303
   – Alcohol Rehab – 220
   – Alcohol Detox – 221
 Modifications
   – Chemical Dependency Detox – 203
   – Chemical Dependency Rehab – 210
   – Designated Inpatient variable ccs 318-360 for other than
     SNF/Long Term Care
   – Designated Inpatient variable ccs 361 to 376 specifically for
     SNF and Long Term Care
   – Designated Special Purpose – Organ Acquisition variable ccs
     as 606 – 615
   – Designated Special Purpose – Other than Organ Acquisition
     variable ccs as 616 – 641                                       4
     Exhibit 15 – Post Stepdown
      Adjustments - Medicaid
 Removal of Chemotherapy Drug Costs
  – Utilize first four lines
      • CC 402 – Chemotherapy Clinic
      • CC 410 – Oncology Clinic
      • 2 lines for variable ccs
  – Captures the appropriate costs for RCC calculations;
  – Costs are removed for reimbursement purposes;
  – Costs are added back for Uncompensated Care
    Calculation.
  – Failure to remove them will result in DOH removing
    all drugs stepped down to the Chemo/Oncology cost
    center.
                                                           5
 Exhibit 18 – Details of Specific Expenses

 Report expenses on this exhibit after reclasses and
  adjustments to expense.

 Malpractice must be reported on line 25 on the
  A & G portion of this exhibit. (Edit established.)

 New line 033 in the A & G portion for the Metro
  Commuter Transportation Mobility Tax.

 Edits established to assure the exhibit 18 expenses
  equal the corresponding expenses on Exhibit 11,
  Medicaid Cost Allocations, column 11.                 6
7
   Exhibit 26B Income/Expense Recovery
 Purpose – To identify where the income reported on
  Exhibit 26A has been offset on Exhibit 14.
 Column 2 fills in automatically from Exh 26A.
 Indicate Y or N in column 3 if offset on Exh 14.
 Column 4 will be the line # from Exh 14.
 Column 5, if the amount was not offset, enter the code for
  the reason why it was not offset.
   – 1 = Non – reimbursable
   – 2 = No related expense on Exhibit 11
   – 3 = Not offsetable
   – 4 = No adjustment required
 Column 6: Enter the non-reimbursable cc if col 5 = 1, or
  if 3 or 4, explain reason for not having to offset.
                                                               8
    Exhibit 32 Inpatient Days and
   Discharges by Source of Payment

 Epilepsy, HIV Alcohol Rehab, and Drug
  Rehab eliminated
 Chemical Dependency Rehab established
 CAH section will have two new columns
  for Newborn Days and for Newborn
  Discharges.


                                          9
    MMTP – Exhibit 33 and 46,
      eMedNY claims data
 Data from Exhibits 33, 46 and eMedNY claims are used by
  DOH in the Upper Payment Limit (UPL) calculation submitted
  to the Centers for Medicare and Medicaid Services (CMS).
 CMS states that Medicare requires that providers maintain a
  charge structure that is uniformly applied to all services. The
  charges reported for MMTP services do not appear to be in
  keeping with this requirement for reporting purposes.
 Exhibit 33 – Report the actual visits; not the number of claims
 Exhibit 46 – Report the full uniform charge amount; not the
  reimbursed amount
 eMedNY claims – Report the full charge amount in the
  appropriate field on the eMedNY claims form for all claims
  with a date of January 1, 2011 and subsequent.
                                                                    10
          Rate Code Mapping
         Exhibits 32, 33, 34 and 46
 Using rate codes to align costs, revenue
  and statistics together
  – For each service reported on Exhibits 32, 33,
    34, and 46, enter the “Number code” listed on
    the next slides that is associated with the
    Medicaid rate code billed. The purpose of the
    rate code mapping is to assist in the alignment
    of a hospital’s visits, charges, and billing rate
    codes to calculate more accurate RCC’s and
    other analysis.
                                                        11
                Inpatient Mapping to Rate Codes
                    To be Used for Exhibits 32 & 46

Number
 Code          Rate Codes                               Service

                                   Acute (Including Ambulance, Organ
  1            2946, 2992          Acquisitions & Swing Beds)
                                   Specialty Acute, Children's Hospital. Note that
                                   Rate Code 2948 in this section applies to Coler
                                   Memorial Hospital and Goldwater Memorial
  2      2947, 2949, 2959, 2948    Hospital ONLY
  3               2852             Psychiatric, CPEP Extended Observation Beds
  4            2957, 2993          Chemical Dependency Rehab
  5               2999             Critical Access Hospital
                                   Medical Rehabilitation [facilities other than
                                   Coler Memorial Hospital and Goldwater
  6            2853, 2948          Memorial Hospital]
  7            4800, 4801          Chemical Dependency Detox
         3810, 3812, 3838, 3839,
                                   Skilled Nursing Facility (SNF)
  8            2862, 2863
         3755, 3756, 3766, 3767,
                                   SNF Aids
               3848, 3849
         3759, 3760, 3775, 3776,
                                   SNF Vent
         3770, 3771, 3760, 3759

         3754, 3845, 3753, 3844    SNF Neurobehavioral

         3762, 3763, 3846, 3847    SNF Pediatrics
         2685, 2689, 2809, 2818,
         2821, 2822, 2824, 2825,
         2826, 2827, 2828, 2829,
         2830, 2831, 2832, 2834,   Long Term Care
         2835, 2836, 2837, 2864,
         2883, 3826, 3827, 9981,                                                     12
            9993, 9994, 9995
  9       Not Tied to Rate Codes   Non-Reimbursable / Non-Billable
              Outpatient/Other Mapping to Rate Codes
                         To be Used for Exhibits 33 & 46


Number
 Code         Rate Codes                                 Service

  20           1400, 1432        APG Clinic & Episode
               1413, 1441        APG OOS Clinic & Episode
               1501, 1489        APG MR/DD/TBI & Episode (Used for both Instate & OOS)
               1444, 1450        APG SBHC & Episode
            1381, 1382, 1383     APG SBHC Vaccine
  21           1401, 1416        APG Amb Surg & APG OOS Amb Surg
  22           1402, 1419        APG ER & APG OOS ER
         4011, 4012, 4013, 2888,
  23              2889           FQHC, FQHC School Based Health Centers
         2841, 2878, 2499, 2842,
  24        2844, 2845, 2847     Home Health Agency (Aides & Therapy)
         2560, 2561, 2562, 2563, Telehealth: Certified Home Health Agencies and Long Term
  25     2544, 2545, 2546, 2547 Home Home Health Care Programs


         4273, 4274, 4275, 4276, Chemical Dependence Outpatient Clinic Program,
         4277, 4278, 4283, 4284, Chemical Dependence Outpatient Rehab Program,
  26     4285, 1528, 1531, 1561 Chemical Dependence Outpatient Youth Programs

  27              2887           Children's Rehabilitation
  28              3091           Day Hospital Visit
         2973, 1531, 1615, 2531, Methodone Maintenance Treatment Program (MMTP),
  29        2532, 2533, 2534     Buprenorphine Fees                                         13
Rate Code Mapping - Exhibit 46
 Rate Code Mapping line 099 – these entries
  will drive the new summary page and align
  the charges and visits as previously
  mentioned.
  –   Total All Services
  –   Inpatient
  –   SNF & LTC
  –   Outpatient
  –   Home Health Agency
  –   Mental Health/OASAS
  –   All Other
                                               14
          Exhibits 40 and 44
 Exhibit 40 – Details of Specific Capital
  Expenses
  – The assignment of variable capital cost centers
    is no longer required.
 Exhibit 44 – Direct Charge Capital
  – If a facility has a direct charge to a cost center
    on this exhibit, there should be an amount
    reported in that cost center in the opening
    balance of the stepdown.
                                                         15
Exhibit 50 Patient Financial Aid
            Report
 In order to ensure that hospitals receiving
  disproportionate share (DSH) payments meet the
  federal mandated requirement related to
  obstetricians under section §1923(d) of the Social
  Security Act, the provider is required to answer a
  series of three (3) questions. No hospital may
  qualify for DSH payments unless the hospital
  has, at a minimum, a Medicaid utilization rate of
  one percent; and, has answered “Yes” (with a Y)
  to one of these three questions.
                                                  16
 Specific Services’ Reporting
 In an effort to increase the reports being
  filed accurately, edits have been pre-
  programmed in the software if providers
  have the following programs and do not
  have an opening stepdown balance in that
  specific cost center.
  – Designated Aids Centers – cc 263
  – WIC Providers – cc 418
  – CPEP Providers – cc 216 and 288
  – Chemical Detox Providers cc 203
                                               17
          Exhibit 51 - RCC
♦ Part I – Remains the same as last year – aligns the
    cost centers with cost center groups (CCGs).
♦   The initial mapping that is provided on the exhibit
    is based on the Department's standard mapping.
♦   A hospital can edit the standard mapping in order
    to refine it for their facility.
♦   If a variable ICR cost center is used and the
    standard CCG mapping displayed is represented
    by an 'XX', the hospital is required to assign this
    ICR cost center to a CCG Number.
♦   The CCG mapping provided in this part will be
    used for the summation of the ICR costs and
    charges by ICR Cost Center into these CCGs.
                                                      18
                        Part I A
 Accumulated routine stepdown costs will flow to this part
   – Chemotherapy post stepdown adjustments will be
      automatically filled by software
   – Provider will data enter any other applicable post stepdown
      adjustments
 Total of all services charges are brought in
   – Distribution of routine charges from Exhibit 46
       • Line 001 – defaults to 201; may be moved
       • Lines 002 and 013- default to 237; may be moved
       • Lines 008 through 012 – variable; needs to be assigned
 Total all Service Charges (class code 45140) should sum to
  class code 0036, line 200 on Exhibit 46.
 Cost and Charges do not equal flag?
   – Return to Exhibits 11 and 46 for review; make changes if
      warranted. Not fatal, but extremely important.             19
                    Part I B
 Routine Charges line 001 other than
  inpatient
  – Defaults to cc 201, can be revised ie, maternity
    cc 215
  – If a delete is not revised, fatal edit
 Routine Charges lines 002 and 013
  – Defaults to cc 237, can be revised
 Routine Charges Variable lines 008 through
  012
  – Needs to be entered by provider. Fatal edit if
    left blank.                                      20
                  Part I C
 RCC by Cost Center Group
  – Comparison of Final Accumulated Routine
    costs and Total all Service Charges based on
    previous entries – fatal
  – Development of RCC
  – Flag if RCC > Medicare Ceiling of 1.604
  – Miscellaneous and Non-Reimbursable ccs’
    RCC set to zero
                                                   21
                  Part I D
 If RCC > than Ceiling
  – Explanation under comment column. State if
    true and explain or correct as necessary.
  – No explanation = fatal edit




                                                 22
            Parts II and III
 Part II - Inpatient Mapping for Revenue
  Codes to CCG
 Part III – Outpatient Mapping for Revenue
  Codes to CCG




                                              23
24
Exhibit 51 Summary
                    Function                               Hospital Data Entry Required
Part I        Same as last year. Aligns the cost              Initial mapping is based on DOH
               centers with the Cost Center Groups.             standards. Providers can refine
                                                                as necessary. Variables require
                                                                Cost Center Group assignments
Part I A      New – Routine cost and charges are              Routine ancillary and final cost
               aligned. If both are not reported, a flag        center stepdown costs are
               will indicate review is required.                automatically adjusted for
                                                                chemotherapy post stepdown
                                                                adjustments and providers will
                                                                adjust for other post stepdown
                                                                adjustments as necessary.
                                                               Examine flag where costs and
                                                                charges are not both reported;
                                                                revise Exhibit 11 and/or Exhibit
                                                                46 as required.
Part I B      Assigns routine costs previously not            Change cost center 201 default if
               assigned (Line 001 other than Inpatient,         necessary for Line 001 costs.
               Lines 002 and 013, and Lines 008 though         Change cost center 237 default if
               012.                                             necessary for line 002 and 013
                                                                costs.
                                                               Assign lines 008 through 012 data
                                                                to appropriate cost center.
Part I C      Final Accumulated Routine Costs and             Examine fatal edit flag if no RCC
               Charges are aligned for RCC calculation.         has been calculated due to costs
              RCC percentage compared to Medicare              and charges not aligning. Revise
               ceiling of 1.604.                                as necessary.
Part I D      RCCs greater than Medicare ceiling are          Examine RCC percentages greater
               listed.                                          than ceiling and explain. Make
                                                                revisions as necessary.
Part II       Same as last year. Inpatient mapping            Assign revenue codes to CCGs.
               from CCGs to Revenue Codes                      Cannot assign CCG to Revenue
                                                                Code if no RCC calculated in
                                                                Part I C.
Part III      Same as last year. Outpatient mapping           Assign revenue codes to CCGs.
               from CCGs to Revenue Codes                      Cannot assign CCG to Revenue
                                                                Code if no RCC calculated in
                                                                Part I C.
                                                                                                    25
        Provider Assistance
♦ DOH to provide overall coordination and
  support
   ―Check FAQ’s on the HPN
   ―Instructions on the HPN
   ―E-mail address: bpacr@health.state.ny.us
   ―Analyst assigned to your facility
♦ Medicare Questions and Issues
   ―Completion of 2552
   ―Medicare Settlement Manager
   ―Software Question
        • DOH via bpacr@health.state.ny.us     26
           Filing Procedures
 Due Date: May 31, 2011
 Submission to DOH
  – DH file (May 31, 2011)
  – Hardcopy (5 business days later)
     • Report ( Including CEO Certification)
     • 2 copies of Audited Financial Statements
     • Initialed Edits


                                                  27
               2010 Audits
 Audits will be replacing the CPA certification
  for reports ending on or after 12/31/2010
   – RHCF – 2 filers, Hospital based Nursing
     Homes will also be audited, not certified.
   – Hospital based RHCF – 4 filers ( ie 28A
     facilities) must have report certified as usual.
 The State will contract with CPA firms to
  conduct audits based upon developed protocols
 The audit will be looking at areas of the ICR
  that are used for various rate setting and
  analysis
 Expect audits for 2010 to begin in late 2011
                                                        28
Questions???????




                   29

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:10
posted:2/5/2013
language:Latin
pages:29