Exhibit 26B Income/Expense Recovery
|
|
- Cecily Glenn
- 8 years ago
- Views:
Transcription
1 NYS Institutional Cost Report ts Seminar HFMA Sessions April 4 8, 2011 John W. Gahan, Jr. Jane Casale Tami Berdi Donna Choiniere Data Integrity Objectives: 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 1
2 2010 Changes Cost Center Matrix Agenda Additions/Modifications/Deletions Provider Assistance Filing Procedures Audit vs. Certification Questions and Answers 3 Cost Center Matrix Deleted Cost Centers Drug Rehab Drug Detox Alcohol Rehab 220 Alcohol Detox 221 Modifications Chemical Dependency Detox 203 Chemical Dependency Rehab 210 Designated Inpatient variable ccs 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 Designated Special Purpose Other than Organ Acquisition variable ccs as
3 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
4 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 4
5 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 5
6 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 , , 2949, 2959, 2948 Acute (Including Ambulance, Organ Acquisitions & Swing Beds) Specialty Acute, Children's Hospital. Note that Rate Code 2948 in this section applies to Coler Memorial Hospital and Goldwater Memorial Hospital ONLY Psychiatric, CPEP Extended Observation Beds , 2993 Chemical Dependency Rehab Critical Access Hospital , 2948 Medical Rehabilitation [facilities other than Coler Memorial Hospital and Goldwater Memorial Hospital] , 4801 Chemical Dependency Detox , 3812, 3838, 3839, 2862, , 3756, 3766, 3767, 3848, 3849 Skilled Nursing Facility (SNF) SNF Aids 3759, 3760, 3775, 3776, 3770, 3771, 3760, 3759 SNF Vent 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, Not Tied to Rate Codes Non Reimbursable / Non Billable 12 6
7 Outpatient/Other Mapping to Rate Codes To be Used for Exhibits 33 & 46 Number Code Rate Codes Service , 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 , 1416 APG Amb Surg & APG OOS Amb Surg , 1419 APG ER & APG OOS ER , 4012, 4013, 2888, 2889 FQHC, FQHC School Based Health Centers 2841, 2878, 2499, 2842, 2844, 2845, 2847 Home Health Agency (Aides & Therapy) 2560, 2561, 2562, 2563, Telehealth: Certified Home Health Agencies and Long Term , 2545, 2546, 2547 Home Home Health lthcare Programs 4273, 4274, 4275, 4276, Chemical Dependence Outpatient Clinic Program, 4277, 4278, 4283, 4284, Chemical Dependence Outpatient Rehab Program, , 1528, 1531, 1561 Chemical Dependence Outpatient Youth Programs Children's Rehabilitation Day Hospital Visit , 1531, 1615, 2531, 2532, 2533, 2534 Methodone Maintenance Treatment Program (MMTP), 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 it as previously mentioned. Total All Services Inpatient SNF & LTC Outpatient Home Health Agency Mental Health/OASAS All Other 14 7
8 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 t 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 8
9 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 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 9
10 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
11 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 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 11
12 Parts II and III Part II - Inpatient Mapping for Revenue Codes to CCG Part III Outpatient Mapping for Revenue Codes to CCG
13 Exhibit 51 Summary Function Part I Same as last year. Aligns the cost centers with the Cost Center Groups. Part I A New Routine cost and charges are aligned. If both are not reported, a flag will indicate review is required. Part I B Assigns routine costs previously not assigned (Line 001 other than Inpatient, Lines 002 and 013, and Lines 008 though 012. Part I C Final Accumulated Routine Costs and Charges are aligned for RCC calculation. RCC percentage compared to Medicare ceiling of Part I D RCCs greater than Medicare ceiling are listed. Part II Same as last year. Inpatient mapping from CCGs to Revenue Codes Part III Same as last year. Outpatient mapping from CCGs to Revenue Codes Hospital Data Entry Required Initial mapping is based on DOH standards. Providers can refine as necessary. Variables require Cost Center Group assignments Routine ancillary and final cost center stepdown costs are 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. Change cost center 201 default if necessary for Line 001 costs. Change cost center 237 default if necessary for line 002 and 013 costs. Assign lines 008 through 012 data to appropriate cost center. Examine fatal edit flag if no RCC has been calculated due to costs and charges not aligning. Revise as necessary. Examine RCC percentages greater than ceiling and explain. Make revisions as necessary. Assign revenue codes to CCGs. Cannot assign CCG to Revenue Code if no RCC calculated in Part I C. Assign revenue codes to CCGs. 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 address: bpacr@health.state.ny.us Analyst assigned to your facility Mdi Medicare Questions and dissues Completion of 2552 Medicare Settlement Manager Software Question DOH via bpacr@health.state.ny.us 26 13
14 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 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
15 Questions??????? 29 15
New York State Medicaid EHR Incentive Program Amendments to Hospital Incentive Payment Calculation
New York State Medicaid EHR Incentive Program Amendments to Hospital Incentive Payment Calculation February 13, 2012 Effective immediately, the NYS Department of Health (DOH) is amending the guidance set
More information2009 Cost Center Setup Cross Reference Exhibit 3, 4, 11, 19, 20, 30, 31A, and 46. Exh 4, S-3. 30 & 31A Line
Setup Cross Reference General Service Assignments (95) (38) Standard 001-026, 029-030, 033, 040-047, 095 (57)Variable 027-028, 031-032, 034-039, 048-094 (Program Capabilities 200) 1 0100 Old Capital Related
More informationPage 2 of 62. Table of Contents
ACTION: Final ENACTED Appendix 5101:3-2-23 DATE: 11/04/2011 8:59 AM Page 1 of 62 Ohio Department of Job and Family Services HOSPITAL COST REPORT (JFS 02930) INSTRUCTIONS For State Fiscal Year 2011 For
More informationEHR Incentive Payments Medicare and Medicaid Indiana
EHR Incentive Payments Medicare and Medicaid Indiana OPTIMIZING EHR PAYMENTS William Rees, CPA Director 317-713-7942 brees@blueandco.com EHR Regulations EHR Incentive Legislation: American Recovery and
More information06/09/11 2010 INSTRUCTIONS INSTITUTIONAL COST REPORT (NYSICR)
06/09/11 2010 INSTRUCTIONS INSTITUTIONAL COST REPORT (NYSICR) Current Year Issues Cost center matrix Deleted Drug Rehab (cc204), Drug Detox (cc303), Alcohol Rehab (cc220), and Alcohol Detox (cc221); Established
More informationBilling Manual for In-State Long Term Care Nursing Facilities
Billing Manual for In-State Long Term Care Nursing Facilities Medical Services North Dakota Department of Human Services 600 E Boulevard Ave, Dept 325 Bismarck, ND 58505 September 2003 INTRODUCTION The
More informationCMS REGULATORY ACTION
CMS REGULATORY ACTIONS CMS REGULATORY ACTION Government Provider Cost Limit Regulation Imposes new restrictions on payments to providers operated by units of government and clarifies that those entities
More informationMassachusetts Hospital Cost Report 1
Massachusetts Hospital Cost Report 1 HOSPITAL STATEMENT OF COSTS, REVENUES, AND STATISTICS 1 MA Hospital Cost Report was last updated in 2016 1 Contents Contents... 2 General Instructions... 8 Tab 1 Identification
More informationPayment Methodology Grid for Medicare Advantage PFFS/MSA
Payment Methodology Grid for Medicare Advantage PFFS/MSA This applies to SmartValue and Security Choice Private Fee-for-Service (PFFS) plans and SmartSaver and Save Well Medical Savings Account (MSA) plans.
More informationNYS Chemical Dependence Services and Detoxification Reform
NYS Chemical Dependence Services and Detoxification Reform Presentation to the Commission on Health Care Facilities in the 21 st Century Shari Noonan, Acting Commissioner, NYS OASAS July 20, 2006 Chemical
More informationNEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE
NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE Version 2011 1 (01/31/11) Page 1 of 23 TABLE OF CONTENTS Section I Purpose Statement... 3 Section II Stop-loss Policy
More informationVermont Medicaid ICD-10 Submission Guidelines. Spanned Claims
Vermont Medicaid ICD-10 Submission Guidelines Spanned Claims 4/07/2015 V2.01 HP Enterprise Services Document Properties Title Subject Filename ICD-10 Submission Guidelines Spanned Claims VT Medicaid Span
More informationHospital Statement of Cost BHF Page 1 Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763
Hospital Statement of Cost BHF Page 1 Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763 General Information Name of Hospital: Jackson Park Hospital 14-0177
More informationUnderstanding Changes to Medicaid Behavioral Health Care in New York. Consumer/Recipient Education Forum
Understanding Changes to Medicaid Behavioral Health Care in New York Consumer/Recipient Education Forum MARCH July 2015 2015 Presentation Overview What are the Goals for the Medicaid Changes? What is Medicaid
More informationProvider Billing Manual. Description
UB-92 Billing Instructions Revision Table Revision Date Sections Revised 7/1/02 Section 2.3 Form Locator 42 and 46 Description Language is being added to clarify UB-92 billing instructions for form locator
More informationOFFICIAL. This attachment describes methods used to determine rates of payment for acute outpatient hospital services.
Attachment 4.19-8 (1) Page 1 I. Introduction A. Overview This attachment describes methods used to determine rates of payment for acute outpatient hospital services. I. For dates of service beginning December
More informationThe PFFS Reimbursement Guide
The PFFS Reimbursement Guide SecureHorizons Direct reimburses claims based on Medicare Fee Schedules, Prospective Payment Systems (PPS) and estimated Medicare payments amounts. Payment methodologies are
More informationIDENTIFYING INFORMATION SOURCES: FORM HCFA 2552-92, WORKSHEET S-2, AND HCFA RECORDS FIELD FIELD NAME DESCRIPTION LINE(S) COL(S) SIZE USAGE LOCATION
Minimum Data Set 08/22/96 IDENTIFYING INFORMATION SOURCES: FORM HCFA 2552-92, WORKSHEET S-2, AND HCFA RECORDS F 1 Provider Number - Hospital 2 2 6 X 1-6 F 2 Provider Number - Subprovider 3 2 6 X 7-12 F
More informationWestchester Medical Center. 2012 Operating Budget
Westchester Medical Center 2012 Operating Budget December 7, 2011 WESTCHESTER COUNTY HEALTH CARE CORPORATION Overview Westchester Medical Center s (WMC) 2012 Operating Budget reflects significant reductions
More informationToday s Agenda. Statement of Conflicts of Interest 7/9/2015
Geri Brennan Assistant Director, Health Care United States Government Accountability Office Statement of Conflicts of Interest Geri Brennan has no actual or potential conflict of interest in relation to
More informationSummary of Medicare s special payment provisions for rural providers and criteria for qualification
A P P E N D I XB Summary of Medicare s special payment provisions for rural providers and criteria for qualification A P P E N D I X B Summary of Medicare s special payment provisions for rural providers
More informationCare Wisconsin ICD-10 FAQs
Care Wisconsin ICD-10 FAQs 1. What are the improvements to ICD-10-CM/PCS coding? Answer: The new classification system provides significant improvements greater detailed information and the ability to
More informationBehavioral Health Management of Substance Use Disorder Services
Behavioral Health Management of Substance Use Disorder Services Arlene González-Sánchez, Commissioner Robert Kent, General Counsel SAMSHA: New York State should remain consistent with SAMSHA policy philosophy
More informationA New Hospital Outpatient Payment Method for Rhode Island Medicaid
A New Hospital Outpatient Payment Method for Rhode Island Medicaid Frequently Asked Questions The Rhode Island Medicaid program will move to a new method of paying for hospital outpatient services based
More informationHospital Statement of Cost OHF Page 1 Illinois Department of Public Aid, Office of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763
Hospital Statement of Cost OHF Page 1 Illinois Department of Public Aid, Office of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763 General Information Name of Hospital: Provena United Samaritans
More informationPolicy and Billing Guidance Ambulatory Patient Groups (APGs)
Policy and Billing Guidance Ambulatory Patient Groups (APGs) P R O V I D E R M A N U A L REVISION 2.1 August 2012 Please Note: Red text indicates new policy clarifications and additions to the manual since
More informationExploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012
Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors
More informationEHR Incentive Funding for Medicare and Medicaid
EHR Incentive Funding for Medicare and Medicaid Implementing the American Reinvestment & Recovery Act of 2009 Mike Stigler, FHFMA, CPA Director 502.992.3510 mstigler@blueandco.com EHR Incentives EHR Incentive
More informationRural Provider Types and Payment Models
Rural Provider Types and Payment Models Emily Jane Cook, JD, MSPH McDermott Will & Emery LLP American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues Baltimore, MD March 20,
More informationAttachment C Behavioral Health Services New York Medicaid Billing Codes
Attachment C Behavioral Health s New York Medicaid Billing Codes Listed below are the New York Medicaid program DRGs, procedure, fee, and rate codes for the Behavioral Health s that are not in the Medicaid
More informationOther Inpatient and Outpatient Facility Provider Narrative Instruction
Other Inpatient and Outpatient Facility Provider Narrative Instruction Complete this section for other inpatient and outpatient facilities that are licensed in Medicaid, that are paid facility rates, and
More informationSince outpatient surgical procedures are limited to approved medically necessary services, no additional benefit limitations are imposed.
ATTACHMENT 3.1-A Page 1c AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED Revised: July 1, 2009 CATEGORICALLY NEEDY Outpatient Hospital Services (Continued) Outpatient Surgical Procedures Coverage of outpatient
More informationWyoming. Eligible Hospitals Meaningful Use Stage 1 User Manual. March 20, 2014 Version 3
Wyoming Eligible Hospitals Meaningful Use Stage 1 User Manual March 20, 2014 Version 3 Table of Contents Table of Contents 1 Background... 1 2 Introduction... 2 3 Eligibility... 3 3.1 Additional requirements
More informationThe Utilization Threshold Program
The Utilization Threshold Program In order to contain costs while continuing to provide medically necessary care and services, the Utilization Threshold (UT) program places limits on the number of services
More informationInpatient Rehabilitation Facility Quality Reporting Program Train-the-Trainer Conference. May 2, 2012. Centers for Medicare & Medicaid Services 1
Division of National Systems Operationalizing Data Submission for ACA Section 3004 Stacy Mandl, RN Division of National Systems Who Are We? The Division of National Systems is located within the Data and
More information2016 Medicaid Managed Care Rate Development Guide
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Disabled and Elderly Health Programs Group Introduction
More informationLouisiana Medicaid School-Based Health Center Presentation December 2011
Louisiana Medicaid School-Based Health Center Presentation December 2011 1 Services Available Professional Services, think of a SBHC as a physician clinic dropped into the school setting. KIDMED Services,
More informationAlcohol and Drug Treatment Beds by a Non- State Entity. HHS LOC Mental Health Subcommittee. February 24, 2013
Alcohol and Drug Treatment Beds by a Non- State Entity HHS LOC Mental Health Subcommittee February 24, 2013 Billy R. West, Jr., MSW, LCSW Executive Director About DAYMARK Our Mission: Daymark Recovery
More informationCareFirst ICD-10 Claim Submission Guidelines
CareFirst ICD-10 Claim Submission Guidelines Introduction The U.S. Department of Health and Human (HHS) has released a HIPAA administration simplification mandate requiring all HIPAA entities to adopt
More informationRural Provider Types and Payment Models
Rural Provider Types and Payment Models Emily Jane Cook, JD, MSPH McDermott Will & Emery LLP American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues Baltimore, MD March 28,
More informationFacilities contract with Medicare to furnish
Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit
More information2009 Medicaid Transformation Program Review Out-of-State Services
2009 Medicaid Transformation Program Review Out-of-State Services Description Kansas Medicaid maintains an out-of-state program for situations which require a Kansas Medicaid beneficiary to receive services
More informationINDEPENDENT CARE HEALTH PLAN
icare ICD-10 FAQs 1. What are the improvements to ICD-10-CM/PCS coding? Answer: The new classification system provides significant improvements greater detailed information and the ability to expand to
More informationDetails for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY. Wednesday, December 30, 2009
Details for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY Return to List For Immediate Release: Contact: Wednesday, December 30, 2009 CMS Office of
More informationCritical Access Hospital (CAH) and CAH Swingbed Questions and Answers
Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers The following questions and answers are from the April 2012 CAH and CAH Swingbed web-based trainings: Q1. Is a non-covered/no pay bill
More informationChapter 7 Acute Care Inpatient/Outpatient Hospital Services
Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care
More informationFiguring Out the Codes: Inpatient Rehabilitation Facilities and the Transfer Policy
Figuring Out the Codes: Inpatient Rehabilitation Facilities and the Transfer Policy Inpatient rehabilitation facilities (IRFs) are hospitals (or subunits of a hospital) that offer intensive rehabilitation
More informationHealth Care Finance 101
Alaska Health Care Commission Health Care Finance 101 Ken Tonjes CFO PeaceHealth Ketchikan Medical Center June 20, 2013 Basics: Glossary of Terms Common Financial Terminology Gross Charges (Revenue) Total
More information8.2000: HOSPITAL PROVIDER FEE COLLECTION AND DISBURSEMENT
DEPARTMENT OF HEALTH CARE POLICY AND FINANCING MEDICAL ASSISTANCE SECTION 8.2000 [Editor s Notes follow the text of the rules at the end of this CCR Document.] 8.2000: HOSPITAL PROVIDER FEE COLLECTION
More informationEHR Incentive Payments For Rural Hospitals and Eligible Providers. April, 2011. Tommy Barnhart, Dixon Hughes Goodman LLP
EHR Incentive Payments For Rural Hospitals and Eligible Providers April, 2011 Tommy Barnhart, Dixon Hughes Goodman LLP Objectives Health Information Technology (HIT) and Electronic Health Record (EHR)
More informationAmbulatory Surgery Center (ASC) Billing Instructions
All related services performed by an ambulatory surgery center must be billed on the UB04 claim form following the instructions listed below. Tips Claim Form Completion Claims for ASC covered services
More informationUnderstanding Changes to Medicaid Behavioral Health Care in New York
Understanding Changes to Medicaid Behavioral Health Care in New York Community Based Provider Education September 2015 Presentation Overview What are the Goals for the Medicaid Changes? What is Changing?
More information09-14 FORM CMS-2552-10 4004 4004. WORKSHEET S-2 - HOSPITAL AND HOSPITAL HEALTH CARE COMPLEX IDENTIFICATION DATA This worksheet consists of two parts:
09-14 FORM CMS-2552-10 4004 4004. WORKSHEET S-2 - HOSPITAL AND HOSPITAL HEALTH CARE COMPLEX IDENTIFICATION DATA This worksheet consists of two parts: Part I - Hospital and Hospital Health Care Complex
More informationNURSING FACILITIES & HOSPITAL BASED NURSING FACILITIES DIVISION OF MEDICAL ASSISTANCE. Provider Check List
NURSING FACILITIES & HOSPITAL BASED NURSING FACILITIES DIVISION OF MEDICAL ASSISTANCE 2016 (Version 5.0 ) Provider Check List Level 1 Edits Cleared.... Working Trial Balance & Supporting Workpapers...
More informationDo not include in column 4 Medicare Secondary Payer/Lesser of Reasonable Cost (MSP/LCC) days
01-10 FORM CMS-2552-96 3605.1 3605. WORKSHEET S-3 - HOSPITAL AND HOSPITAL HEALTH CARE COMPLEX STATISTICAL DATA AND HOSPITAL WAGE INDEX INFORMATION This worksheet consists of three parts: Part I - Hospital
More informationNORTHEASTERN VERMONT REGIONAL HOSPITAL EXECUTIVE SUMMARY OPERATING AND CAPITAL BUDGETS FOR FISCAL YEAR ENDING SEPTEMBER 30, 2013
NORTHEASTERN VERMONT REGIONAL HOSPITAL EXECUTIVE SUMMARY OPERATING AND CAPITAL BUDGETS FOR FISCAL YEAR ENDING SEPTEMBER 30, 2013 On behalf of Northeastern Vermont Regional Hospital (NVRH), I am pleased
More informationMMA - Medicare Prescription Drug, Improvement and Modernization Act of 2003 Information for Medicare Rural Health Providers, Suppliers, and Physicians
Related Change Request (CR) #: N/A Effective Date: N/A Implementation Date: N/A MMA - Medicare Prescription Drug, Improvement and Modernization Act of 2003 Information for Medicare Rural Health Providers,
More informationTennessee Medicaid Supplemental Cost Report
Tennessee Medicaid Supplemental Cost Report Frequently Ask Questions Contents General Filing Questions:... 2 Change of Ownership:... 3 Central/Home Office Cost Report:... 3 Schedule B Statistical Data:...
More informationPlace of Service Codes for Professional Claims Database (updated November 1, 2012)
Place of Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity
More informationClarification of Patient Discharge Status Codes and Hospital Transfer Policies
The Acute Inpatient Prospective Payment System Fact Sheet (revised November 2007), which provides general information about the Acute Inpatient Prospective Payment System (IPPS) and how IPPS rates are
More informationPayment by Provider Type for MedicareBlue PPO Covered Services...3
Payment by Provider Type...2 Dual Eligibility and MedicareBlue PPO...2 Payments for Medicare Incentive Programs...2 General Claims Submission Guidelines...2 Payment by Provider Type for MedicareBlue PPO
More informationPlace of Service Codes for Professional Claims Database (updated August 6, 2015)
Place of Codes for Professional Claims Database (updated August 6, 2015) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity
More informationUnderstanding October 1 st MDS Changes and PEPPER Letters 2013
Understanding October 1 st MDS Changes and PEPPER Letters 2013 Agenda Changes in the MDS MDS Item Changes Reporting Rehab Minutes Hospital Inpatient Criteria (Two Midnight Provision) Reading PEPPER Letters
More informationInstructions for Schedule H (Form 990)
2011 Instructions for Schedule H (Form 990) Hospitals Department of the Treasury Internal Revenue Service Contents Page requirements a hospital organization Purpose of Schedule General Instructions...
More informationOptum/OptumHealth Behavioral Solutions of California 1 Facility Network Request Form/Credentialing Application INSTRUCTIONS
Optum/OptumHealth Behavioral Solutions of California 1 Facility Network Request Form/Credentialing Application INSTRUCTIONS Read these instructions carefully. It is strongly recommended that an administrative
More informationFinally... maybe? The Long Awaited 340B Mega Guidance. Georgia Healthcare Financial Management Association. October 2015
Finally... maybe? The Long Awaited 340B Mega Guidance Georgia Healthcare Financial Management Association October 2015 Disclaimer This webinar assumes the participant is familiar with the basic operations
More informationBest Practices in Managing Critical Access Hospitals
Best Practices in Managing Critical Access Hospitals Presented by Ann King White, CPA BKD, LLP August 3, 2012 AZ Rural Flex Program 2012 Performance Improvement Summit acumen insight ideas attention reach
More informationHIT Incentives: CMS Proposed Meaningful Use Rule and ONC Interim Final Rule on Standards and Certification
HIT Incentives: CMS Proposed Meaningful Use Rule and ONC Interim Final Rule on Standards and Certification Ivy Baer, J.D., M.P.H. Director & Regulatory Counsel ibaer@aamc.org; 202-828-0499 Lori Mihalich-Levin,
More informationCoverage Basics. Your Guide to Understanding Medicare and Medicaid
Coverage Basics Your Guide to Understanding Medicare and Medicaid Understanding your Medicare or Medicaid coverage can be one of the most challenging and sometimes confusing aspects of planning your stay
More informationTotal Cost of Care and Resource Use Frequently Asked Questions (FAQ)
Total Cost of Care and Resource Use Frequently Asked Questions (FAQ) Contact Email: TCOCMeasurement@HealthPartners.com for questions. Contents Attribution Benchmarks Billed vs. Paid Licensing Missing Data
More informationTECHNICAL HANDBOOK FOR ENVIRONMENTAL HEALTH AND ENGINEERING VOLUME II - HEALTH CARE FACILITIES PLANNING PART 11 - FACILITIES PLANNING GUIDELINES
CHAPTER 11-5 - COST ANALYSIS METHODOLOGY - DIRECT VERSUS CONTRACT INPATIENT CARE 11-5.1 PURPOSE..................... (11-5) 1 11-5.2 INTRODUCTION.................. (11-5) 1 11-5.3 METHODOLOGY...................
More informationFederally Qualified Health Center Billing and Coverage
Federally Qualified Health Center Billing and Coverage May 1, 2014 Today s Presenter Mimi Vier, CPC Provider Outreach and Education Consultant 2 Disclaimer National Government Services, Inc. has produced
More informationRegulatory Compliance Policy No. COMP-RCC 4.32 Title:
I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.32 Page: 1 of 4 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)
More informationHome Health Billing Scenarios - DRAFT. Disclaimer
Home Health Billing Scenarios - DRAFT 1493_1013 Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract
More informationFinancial Analysis 2009 Volume Three Rehabilitation Care Psychiatric Care Long-Term Acute Care Specialty Care
An Annual Report on the Financial Health of Pennsylvania s Non-GAC Hospitals Financial Analysis 2009 Volume Three Rehabilitation Psychiatric Long-Term Acute Specialty Pennsylvania Health Cost Containment
More informationFederally Qualified Health Centers (FQHC) Billing 1163_0212
Federally Qualified Health Centers (FQHC) Billing 1163_0212 Today s Presenter Charles Wiley- Provider Outreach and Education Representative 2 Disclaimer has produced this material as an informational reference
More informationInpatient Transfers, Discharges and Readmissions July 19, 2012
Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle
More information1. Long Term Care Facility
Table of Contents 1.... 1 1.1. Introduction... 1 1.1.1. General Policy... 1 1.1.2. Advance Directives... 1 1.1.3. Customary Fees... 1 1.1.4. Covered Services... 1 1.1.5. Swing Bed General Policy... 2 1.2.
More informationChemical Dependency Services In Monroe County, New York
Chemical Dependency Services In Monroe County, New York CCSI Consolidated Fiscal Report Database Monroe County Community Chemical Dependency Services 2007 Year End Results AGENCIES INCLUDED: ACTION FOR
More informationWyoming. Eligible Professional Meaningful Use Modified Stage 2 User Manual for Program Year 2015. April 2015 Version 1
Wyoming Eligible Professional Meaningful Use Modified Stage 2 User Manual for Program Year 2015 April 2015 Version 1 Table of Contents 1 Background... 1 2 Introduction... 2 3 Eligibility... 3 3.1 Out-of-State
More informationSeptember 4, 2012. Submitted Electronically
September 4, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1589-P P.O. Box 8016 Baltimore, MD 21244-8016
More informationMedicare-Medicaid Crossover Claims FAQ
Medicare-Medicaid Crossover Claims FAQ Table of Contents 1. Benefits of Crossover Claims... 1 2. General Information... 1 3. Medicare Part B Professional Claims and DMERC Claims... 2 4. Professional Miscellaneous...
More informationAppendix A. Glossary
Glossary The following provides brief definitions and descriptions of terms, abbreviations, and acronyms often used in the conjunction with the Medicaid program. AI is an indicator in the CAP block on
More informationTelemedicine and Telehealth in Context. Jonathan Neufeld, PhD Clinical Director Upper Midwest Telehealth Resource Center
Telemedicine and Telehealth in Context Jonathan Neufeld, PhD Clinical Director Upper Midwest Telehealth Resource Center 1 Definitions and Concepts Telehealth and Telemedicine Sometimes used interchangeably
More information(A) Information needed to identify and classify the hospital, include the following: (b) The hospital number assigned by the department;
3701-59-05 Hospital registration and reporting requirements. Every hospital, public or private, shall, by the first of March of each year, register with and report to the department of health the following
More informationMedicare DSH: What is in the Proposed Rule and What it Means for Hospitals. May 23, 2013
Medicare DSH: What is in the Proposed Rule and What it Means for Hospitals May 23, 2013 1 Overview Pre-ACA Medicare DSH Program ACA Medicare DSH Reduction and Revised Methodology CMS Proposal Next Steps
More informationElectronic Health Record Incentive Payments
Agenda Electronic Health Record Incentive Payments New cost reporting forms 2552-10 requirements related to EHR incentive Current reimbursement and operational topics 2 Electronic Health Record Incentive
More informationWhat to know if Medicare denies coverage
What to know if Medicare denies coverage What Medicare covers Necessary post-hospital extended care for up to 100 days Extended care: nursing care and rehab provided to a Medicare beneficiary who is an
More informationUB-04, Inpatient / Outpatient
UB-04, Inpatient / Outpatient Hospital (Inpatient and Outpatient), Hospice (Nursing Home and Home Services), Home Health, Rural Health linic, Federally Qualified Health enter, IF/MR, Birthing enter, and
More informationHealth Care Services Overview. Pennsylvania Department of Corrections
Health Care Services Overview Pennsylvania Department of Corrections Richard S. Ellers Director Bureau of Health Care Services Pennsylvania Department of Corrections rellers@pa.gov 717-728-5311 27 State
More informationDEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW
DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW North Carolina General Assembly Fiscal Research Division February 2005 Overview Purpose of Medicaid Impact of Medicaid - On the State Economy
More informationFrequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013
Frequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013 1. Q. Why is CMS conducting manual review on therapy claims? A. On January 2. 2013 President Obama signed into
More informationJane Snecinski Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com. RAC National Summit
Jane Snecinski P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com RAC National Summit Inpatient Rehab Patients Not Meeting Medical Necessity Criteria Late Submissions of PAI Outpatient Therapy
More informationInpatient or Outpatient Only: Why Observation Has Lost Its Status
Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning
More informationMEDICAID ELECTRONIC HEALTH RECORD INCENTIVE PROGAM. Requirements
MEDICAID ELECTRONIC HEALTH RECORD INCENTIVE PROGAM Requirements Original: May 2, 2011 Updated: September 11, 2014 Table of Contents Introduction... 3 Resources:... 3 Background... 3 Eligibility... 4 Additional
More informationUsing Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota
Using Medicare Hospitalization Information and the MedPAR Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota MedPAR Medicare Provider Analysis and Review Includes information
More informationProvider Electronic Solutions Software Example of a Routine Long Term Care Facility Stay
Example of a Routine Long Term Care Facility Stay This claim example shows a claim where a patient was in the facility for 31 days. Header 1 Tab If the patient status billed is: 20 Expired 30 Still a patient
More informationNOTICE OF PROPOSED AGENCY ACTION. MassHealth: Payment for Chronic Disease and Rehabilitation Hospital Services effective October 1, 2014
NOTICE OF PROPOSED AGENCY ACTION SUBJECT: AGENCY: MassHealth: Payment for Chronic Disease and Rehabilitation Hospital Services effective October 1, 2014 Massachusetts Executive Office of Health and Human
More informationPreface. Summary of Changes. Table of Contents. Service Contacts. October 2014 Replaces: May 2014 S-5781 10/14
Preface Summary of Changes Table of Contents Service Contacts October 2014 Replaces: May 2014 S-5781 10/14 Preface The Wellmark Provider Guide and specialty guides are billing resources for providers doing
More informationToday s Topics. Session 2: Introduction to Drug Treatment. Treatment matching. Guidelines: where should a client go for treatment?
Session 2: Introduction to Drug Treatment Today s Topics Level of care determination How to know when treatment works What does treatment include Description of treatment modalities Naomi Weinstein, MPH
More information