Tennessee Medicaid Supplemental Cost Report

Transcription

1 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:... 4 Schedule C Specific Cost:... 5 Schedule D Medicaid Only Adjustments:... 7 Schedule E Charges:... 8

2 Frequently Asked Questions (FAQs) General Filing Questions and Information 1. Q: Where can I access the TN Medicaid supplemental cost report? A: The TN Medicaid supplemental cost report can be accessed at the following website address: 2. Q: Where can I access the information from the webinar? A: A copy of the webinar slides and the webinar recording can be accessed at the following website address: 3. Q: What cost reporting period is due by 12/4/2015? A: All required documentation for cost reporting periods ended 4/1/2014 3/31/2015 should be filed to NFCostReport@cot.tn.gov by 12/4/ Q: What do I file for my 2015 year end cost report? A: Providers with cost reporting periods ended after 3/31/2015 will continue to file the required documentation (NF1 and NF2 cost reports, etc.) under the current cost reporting system. These providers will not be required to file the TN Medicaid supplemental cost report at this time. 5. Q: The add ins menu and other Excel macro related functionality does not appear to be working in the template I downloaded. A: The first troubleshooting step will be to ensure that Microsoft Excel macros have been enabled. The TN Medicaid supplemental cost report form instructions have details on how to accomplish this task. After changing your security settings to allow macros, it will be necessary to close out of Microsoft Excel entirely, and then open the applicable file. With the file open, Excel macros can now be fully enabled by the user and functionality may be returned. If troubleshooting step one does not work, the user will need to look at the Excel file type in which the cost report was saved. The cost report should be saved as a.xls or.xlsm Excel file type (the download file is a.xlt) as these file types support macros. If the provider has accidentally saved the cost report as a.xlsx Excel file type, macros will have been stripped from the file rendering them unusable. In order to return the macro functionality to the file, Myers and Stauffer will need to be contacted as there is no other method to restore the functionality. Myers and Stauffer can be contacted at (800) , or through at TNCaseMix@mslc.com.

3 6. Q: My facility does not have dually certified (Medicare/Medicaid) beds, do I still have to file the TN Medicaid supplemental cost report? A: Yes, providers that are not Medicare certified facilities still must file the TN Medicaid supplemental cost report. The providers however will not need to complete the Medicare line numbers and Medicare line description fields present on schedule C and D of the TN Medicaid supplemental cost report. On schedule E no line number must be entered, but ancillary cost center descriptions must be entered. 7. Q: The Tennessee Office of the Comptroller previously has collected some of the information requested on the Required Information schedule of the cost report. Do I need to resubmit this information? A: Yes, all information on the Required Information schedule must be submitted for the cost report. Should there be some extenuating circumstances, please contact Myers and Stauffer at (800) , or through at TNCaseMix@mslc.com. Changes Of Ownership 8. Q: My facility went through a change of ownership in 2014, what cost reporting periods will I need to file for 12/4/2015? A: Only cost reporting periods that are 6 months or greater should be filed. If the new owners cost reporting period does is not 6 or more months please contact Myers and Stauffer at (800) , or through at TNCaseMix@mslc.com. Central/Home Office Cost Report 9. Q: Do I have to file my central office (home office) cost report with each one of my cost report submissions? A: No, you will only need to file your central office cost report one time. You are requested to provide with your submission a listing of the Tennessee nursing home providers to which the central office cost report applies. 10. Q: I have a related party management company, am I required to file the cost report on the CMS Home Office Cost Report Form (CMS Form ) if I do not file on that cost report for Medicare purposes?

4 A: No, all that is required for filing is a management company allocation schedule. The allocation schedule should include the listing of all providers that receive expense from the management company, as well as the mechanism of allocation. Schedule B Statistical Data 11. Q: My facility has permanent single occupancy rooms, but also semi private rooms that are temporarily converted to private rooms due to resident need. What private room days and beds should be included on schedule B of the cost report? A: Only permanent single occupancy rooms that are designated as a permanent residence for a nursing facility resident should be included. Private rooms that are temporarily single occupancy rooms due to infection control, resident behavior issues, or other items should not be included on schedule B. Also, permanent single occupancy rooms that are used solely for temporary resident stays such as infection control should not be included on schedule B. 12. Q: Should private room resident days be inclusive or exclusive of bed hold days? A: Private room days on schedule B should be exclusive of bed hold days. 13. Q: Resident days from S 3 part I of my Medicare cost report will not reconcile exactly to the resident days from my in house census for the cost reporting period. Which days should I use? A: The facility should utilize the days that they believe to be the most accurate, which is traditionally the in house census days. Resident days from S 3 part I of the Medicare cost report will not reconcile by payer type to the in house census due to a variety of reasons, but should traditionally reconcile in total to in house census days (less bed hold/leave days). The state is aware of that certain reconciling items (updated PS&Rs, etc.) can exist between the Medicare cost report and the in house census days and therefore these two reports will not reconcile in total. That is why the state requests the provider file the resident days they believe to be most accurate as of the filing of the TN Medicaid supplemental cost report. 14. Q: Are private room beds and private room resident days on schedule B a subset of total beds and total resident days or are they a separate calculation? A: Private room resident days and private room beds are a subset of total resident days and total beds. For instance, if the nursing facility has a total of 100 beds and 10 of those are permanent private rooms, 100 beds would be entered in the licensed beds section, and 10 beds would be entered in the private room beds section of schedule B 1.

5 Schedule C Specific Cost 15. Q: Do I only enter costs on this schedule related to Skilled Nursing Facility/Nursing Facility? A: This answer depends on which section of Medicare cost report worksheet A the expense is located in. Please see the cost reporting instructions for numerical examples. If the expense is located in a general service (overhead) cost center on the Medicare cost report, then the amount of the expense listed on schedule C of the TN Medicaid supplemental cost report should be the total amount of the specific cost expense regardless of business entity. For example, if the nursing facility is hospital based and Director of Nursing expense is located in a general service cost center, then schedule C should be inclusive of total hospital and nursing facility Director of Nursing Expense. If the expense if located in a non general service (routine, ancillary, outpatient, special purpose, non reimbursable) cost center, then only the SNF/NF portion of expense should be input on schedule C of the TN Medicaid supplemental cost report. For example, if the nursing facility is hospital based and Director of nursing expense is located in the routine cost centers, then only the SNF/NF portion of expense should be entered. 16. Q: I have specific cost expenses in multiple general ledger accounts, should each of these account numbers be entered on a separate line of schedule C? A: If the multiple general ledger accounts all relate to the same specific cost expense (i.e. RN, etc.), the expense is on the same Medicare cost report line, and all of the accounts are salary or all accounts are non salary, then they should be entered on the same line on schedule C of the TN Medicaid supplemental cost report. If any of the general ledger accounts differs in Medicare cost center line number, or salary/other expense type, then it must be entered on a separate line of schedule C. Please see the cost reporting instructions for a numerical example. 17. Q: What support can be provided to satisfy the Required Information tab request, Supporting documentation for the working trial balance accounts included as specific costs on schedule C of this cost report. A reconciliation/explanation must also be provided when schedule C contains only a portion of a working trial balance account. This may be included as part of the facility grouping schedule/crosswalk. (Microsoft Excel format)? A: This requirement is twofold. First, the provider must indicate, either on their working trial balance, crosswalk, or supplementary document, all of the account numbers that are included on each specific cost line of the TN Medicaid Supplemental cost report schedule C. This is most easily accomplished by including supplemental cost report line numbers on your crosswalk, in addition to the Medicare cost report line numbers already present. The purpose behind this request is that providers may have a large number of working trial balance (WTB) accounts that would belong on one line of schedule C, and it can quickly become difficult for cost report reviewers to view or make sense of the WTB account numbers entered.

6 Second, it is common for providers to enter only a portion of a WTB account on a schedule C line. This is typical with salary accounts that encompass many staff of varying licensure. It is important that the provider submit support for how the WTB has been allocated to each schedule C specific cost line. This support would include any allocation basis utilized to segregate the WTB cost and any additional documents that detail how the allocation basis was created. 18. Q: My facility s provider assessment was offset from allowable cost on worksheet A of the Medicare cost report. Do I need to include that expense on schedule C of the TN Medicaid supplemental cost report, and if so how do I do that? A: No, if the provider assessment has been removed from total Medicare cost report worksheet A expense, then the provider assessment will not need to be entered on schedule C of the TN Medicaid Supplemental cost report. 19. Q: I have an RN at my facility that is the MDS Coordinator, do I include their salary with the RN lines on schedule C of the TN Medicaid supplemental cost report, or the MDS Coordinator lines? A: You must enter individuals based on the service they are performing, not the job title. If the RN is the full time MDS coordinator, then you would enter the total salary for this individual on the MDS Line. If the employee was a part time MDS coordinator and a part time RN at the facility, then the salary must be split between the RN and MDS coordinator lines based on the employee s time performing both functions. 20. Q: Where should case management staff be entered on schedule C of the TN Medicaid supplemental cost report? A: You may enter case management staff on the social services lines of schedule C. 21. Q: My facility s dietary function, including raw food, is performed by a third party contractor. How can I include raw food expense on the TN Medicaid supplemental cost report? A: The answer depends on the contract you have with that third party entity. Many times these contracts are broken down on a per resident per day fee structure. If within the contract it specifies what portion of the fee relates to raw food, then that amount should be utilized to derive the raw food total to include on the TN Medicaid supplemental cost report. If the contract does not have a raw food break down, then the facility should contact their dietary vendor and request an attestation of what percentage raw food encompasses of their fee. The Tennessee Office of the Comptroller may require additional supporting documentation at a future date, but the above will satisfy the initial filing requirement.

7 Schedule D Medicaid Only Adjustments 22. Q: Do I need to enter my Medicare cost report A 8 series worksheet adjustments on this schedule? A: No, this schedule is designed to make adjustments to the Medicare cost report for Medicaid purposes. Items previously adjusted on the Medicare cost report would not be entered on this schedule, as this would cause those adjustments to be made a second time to the Medicare cost report. 23. Q: My facility traditionally makes Medicaid only capital adjustments to allow for a step up or stepdown basis in asset historical cost values for Medicaid purposes. Do I need to make these adjustments on schedule D of the TN Medicaid supplemental cost report? A: No, these adjustments do not need to be made under the new case mix system. The Medicare provider reimbursement manual (CMS Publication 15 1) contains the regulations that need be followed for capital purposes. 24. Q: What support can be provided to satisfy the Required Information tab request, Supporting documentation for the working trial balance accounts included for expenditures identified on schedule D of this cost report. A reconciliation/explanation must also be provided when schedule D contains only a portion of a working trial balance account. This may be included as part of the facility grouping schedule/crosswalk. (Microsoft Excel format)? A: The provider may enter full or partial working trial balance account totals on schedule D of the TN Medicaid Supplemental cost report. If only full working trail balance accounts are included on schedule D, then the provider must indicate, either on their working trial balance, crosswalk, or supplementary document, all of the account numbers that are included on each line of schedule D. This is most easily accomplished by including supplemental cost report line numbers on your crosswalk, in addition to the Medicare cost report line numbers already present. If partial working trial balance accounts are included on schedule D, then the provider must submit support for how the WTB has been allocated to each schedule D line number. This support would include any allocation basis utilized to segregate the WTB cost and any additional documents that detail how the allocation basis was created. 25. Q: In the previous NF1 cost report we offset the cost of ancillary expenses, will we need to make those adjustments on schedule D of the TN Medicaid Supplemental cost report? A: No, the direct or indirect ancillary cost center expense will not need to be offset by the provider under the new case mix system.

8 Schedule E Charges 26. Q: I have revenues from non routine and non ancillary areas, where do they get included on schedule E of the TN Medicaid supplemental cost report? A: Non routine and Non ancillary revenues are not included on schedule E 1 or E Q: If my non routine and non ancillary areas are not included on schedule E of the TN Medicaid supplemental cost report, then the schedule F Net Patient Service Revenue number will not reconcile to Medicare cost report worksheet G 3. What should I do? A: The definition for SNF/NF Net Patient Service Revenue (NPSR) from the Tennessee Code Annotated differs for the net patient service revenue calculated on Medicare cost report worksheet G 3, so it is possible that the two numbers will not reconcile. To see the definition for SNF/NF NPSR from the Tennessee Code Annotated please see the cost reporting instructions. 28. Q: My facility has more business entities than just a SNF/NF. Where do I report their revenues on schedule E of the TN Medicaid supplemental cost report? A: Routine cost center revenues for Non SNF/NF entities should be combined and reported on line 3 of schedule E 1 of the TN Medicaid supplemental cost report. The ancillary cost center revenues for the Non SNF/NF entities should be combined by ancillary cost center and entered in column (h) of schedule E 2. All non routine or non ancillary revenues are excluded from this schedule. 29. Q: What is considered an ancillary cost center? A: For the (SNF/NF) Medicare cost report form, cost center lines are considered ancillary/therapy cost centers. For the (Hospital Based NF) Medicare cost report form, cost center lines are considered ancillary/therapy cost centers.