Proposed Medicare Cost Reporting Changes for FY 2019

Last month CMS released proposed rules for the fiscal year 2019 for hospital inpatient prospective payment system (IPPS). There are a number of proposed Medicare cost reporting changes you should know, and all of them would be applied to cost reporting periods beginning on or after October 1, 2018. The most impactful among them would be that certain cost reports could be rejected for lack of supporting documentation.

Charity care

Hospitals and health systems that report charity care and/or uninsured discounts in order to receive additional uncompensated care payments for DSH-eligible hospitals would be required to include: Patients’ names, their dates of service, insurers, the total quantity of charity care and/or uninsured discounts given

Chain organization costs

Also for cost reporting periods beginning on or after October 1, 2018, CMS has proposed that providers who claim allocated home office or chain organization costs would be required to submit a cost statement completed by the home office or chain organization. The total on the cost statement would need to correspond to the amounts listed in their cost report.

Intern and resident information system (IRIS) data

Teaching hospitals’ cost reports would be rejected if their IRIS data does not contain the same totals of “weighted” and “unweighted” direct graduate medical education (DGME), full-time equivalent (FTE) residents and indirect medical education (IME).

Providers claiming bad debt

Those providers who claim Medicare bad debt reimbursement would be required to send a detailed Medicare bad debt listing that would include patients’ names, their dates of service, their Medicaid status (if applicable), the dates the providers’ collection efforts ceased, as well as the deductible and coinsurance amounts. These listings would have to correspond with the bad debt amounts claimed in their cost report.

DSH payments

Hospitals who claim a disproportionate share hospital (DSH) payment adjustment would need to send a detailed listing of their Medicaid eligible days. These would have to correspond to the Medicaid eligible days claimed in their cost report. Also, amended cost reports that change the provider’s Medicaid eligible days would have to include an amended listing that corresponds to the Medicaid eligible days claimed in the amended cost report.

These proposals were published in the Federal Register on May 7, 2018. The comment period ends at 5pm June 25, 2018. Click here to Submit a Formal Comment.

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