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
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 - 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 2
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 3
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
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
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 1 2946, 2992 2 2947, 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 3 2852 Psychiatric, CPEP Extended Observation Beds 4 2957, 2993 Chemical Dependency Rehab 5 2999 Critical Access Hospital 6 2853, 2948 Medical Rehabilitation [facilities other than Coler Memorial Hospital and Goldwater Memorial Hospital] 7 4800, 4801 Chemical Dependency Detox 8 3810, 3812, 3838, 3839, 2862, 2863 3755, 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, 9993 9994 9995 9 Not Tied to Rate Codes Non Reimbursable / Non Billable 12 6
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 23 24 4011, 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 25 2544, 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, 26 4285, 1528, 1531, 1561 Chemical Dependence Outpatient Youth Programs 27 2887 Children's Rehabilitation 28 3091 Day Hospital Visit 29 2973, 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
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
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 9
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 10
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 11
Parts II and III Part II - Inpatient Mapping for Revenue Codes to CCG Part III Outpatient Mapping for Revenue Codes to CCG 23 24 12
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 1.604. 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 E-mail 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
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 14
Questions??????? 29 15