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Things to Look for in Monitoring the Cost Report Process. HCCA’s 2000 Compliance Institute September 25, 2000 New Orleans, Louisiana. Introduction. Compliance issues related to the external reporting of organizational information often associated with financial reporting
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Things to Look for in Monitoring the Cost Report Process HCCA’s 2000 Compliance Institute September 25, 2000 New Orleans, Louisiana Al Josephs Hillcrest Health System
Introduction • Compliance issues related to the external reporting of organizational information often associated with financial reporting • Contact information: • ajosephs@hillcrest.net • 254-202-8620 Al Josephs Hillcrest Health System
Samples of External Reporting • Provider Cost Report Reimbursement Questionnaire HCFA-339 (PCCRQ) • Cost Report HCFA 2552 • Bond Issue Covenants • AHA Annual Survey Al Josephs Hillcrest Health System
Provider Cost Report Reimbursement Questionnaire HCFA-339 (PCCRQ) • Document required to be submitted with the Cost Report • Purpose: To assist in the preparation of an acceptable cost report and to minimize the need for direct contactbetween the provider and the intermediary Al Josephs Hillcrest Health System
PCCRQ HCFA339 • Categories of Questions • Organization and Operations • Financial Data • Insurance • Deferred Compensation • EducationalActivities • Non-paid Workers Al Josephs Hillcrest Health System
PCCRQ HCFA 339 • Categories of Questions--cont’d • Purchased services • Provider based physicians • Bad debts • Bed complement • Owner/Management comp. • Wage relatedcost Al Josephs Hillcrest Health System
PCCRQ HCFA 339 • Assignment of Responsibility • Human Resources • Senior Management • Finance/Reimbursement • Patient Accounting Al Josephs Hillcrest Health System
PCCRQ HCFA 339 • Prioritize your approach (based upon identified risk within your organization): 1. Provider based physicians 2. Purchased services 3. Bad debts 4. Wage/Compensation issues Al Josephs Hillcrest Health System
PCCRQ HCFA 339 Provider Based Physicians Review Plan • Identify related questions • Compile related rules and regulations • Review all agreements • Review related policies and procedures Al Josephs Hillcrest Health System
Cost Report HCFA-2552 • Document for reporting the cost of health care services provided to Medicare beneficiaries • Purpose: To supply information required to determine annual program reimbursement and provide a data base to aid in the management of Federal programs Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Representation & Certification Statement See Handout Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Table of Contents 100 Depreciation 200 Interest Expense 300 Bad Debts, Charity, and Courtesy Allowances 400 Cost of Educational Activities 500 Research Costs 600 Grants, Gifts, and Income From Endowments Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Table of Contents--cont’d 700 Value of Services of Nonpaid Workers 800 Purchase Discounts and Allowances and Refunds of Expenses 900 Compensation of Owners 1000 Cost to Related Organizations 1200 Return on Equity Capital of Proprietary Providers Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Table of Contents--cont’d 1400 Reasonable Cost of Therapy and Other Services Furnished by Outside Suppliers 2100 Costs Related to Patient Care 2200 Determination of Cost of Services to Beneficiaries 2300 Adequate Cost Data and Cost Finding Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Table of Contents--cont’d 2400 Payment to Providers Limitations on Coverage of Costs Under Medicare and Notice of Schedule of Limits on Provider Costs 2600 Lower of Cost or Charges 2700 ESRD Services and Supplies 2800 Prospective Payments Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Table of Contents--cont’d 2900 Provider Payment Determination And Appeals Procedures 3000 NON-PPS Hospitals and Distinct Part Units Al Josephs Hillcrest Health System
Cost Report HCFA-2552 • Prioritize your approach (based on identified risk within your organization): 1. Cost Finding Statistics Square feet Pounds of laundry Hours of service Meals served Al Josephs Hillcrest Health System
Cost Report HCFA-2552 • Prioritize your approach:--cont’d 2. Non-Reimbursable Cost 3. Non-Reimbursable Cost Centers 4. Bad Debt, Charity, and Courtesy Allowance 5. Education Al Josephs Hillcrest Health System
Cost Report HCFA-2552 Bad Debt, Charity, and Courtesy Allowance Review Plan • Evaluation of policy and procedures • Review of any FI audit adjustments • Interviews with staff • Flow chart of process Al Josephs Hillcrest Health System
Other External Reporting • Bond Covenants • AHA Annual Survey • IRS Form 990 Tax-exempt organizations Al Josephs Hillcrest Health System
Conclusion Responsibility for completion of these documents has traditionally been assigned to the finance/reimbursement functions in most organizations. The compliance professional will have little to add to the “number crunching” components of the process. Al Josephs Hillcrest Health System
Conclusion The skills of the compliance professional are expected to be focused on the related rules and regulations, instructions, and the evaluation, testing, and monitoring of the many processes that bring the required information together for use in external reporting. Al Josephs Hillcrest Health System
