Medicare Cost Reporting

1. Medicare Cost Reporting HomeTown Health University Module One Background Information Presented by: Draffin & Tucker, LLP

2. Medicare • Medicare: • Program designed to provide healthcare coverage for the aged and/or disabled • Federally regulated • Federally funded • Fiscal Intermediaries administer program • Georgia Medicare Intermediary – Blue Cross Blue Shield of Georgia

3. Medicaid • Medicaid: • Program designed to provide healthcare coverage for the low income population • State regulated within federal guidelines • State funded with federal match • State agencies administer program • Georgia Medicaid – Department of Community Health • ACS and CMOs - Contract with DCH to process and pay claims

4. Healthcare Accounting Terminology

5. Terminology • CHARGES: • Amounts billed to patients at the facility’s established rates for services rendered. • COSTS: • Expenses incurred in rendering services to patients.

6. Terminology • REIMBURSEMENT: • The amount of payment the facility is required to accept under applicable laws or contractual agreements for services rendered to patients. • CONTRACTUALS: • The difference between the facility’s charges and reimbursement.

7. Reimbursement Methods

8. Reimbursement Methods • FEE SCHEDULE: • Payment made based on a list of uniform rates. • PER DIEM: • Payment made based on a specific daily rate. • FLAT RATE: • Payment made at a set, all-inclusive rate.

9. Reimbursement Methods • PROSPECTIVE PAYMENT SYSTEM (PPS) • Payment made at a predetermined, specific rate • Diagnosis Related Group (DRG) • Ambulatory Payment Classification (APC) • Resource Utilization Group (RUG)

10. Reimbursement Methods • COST BASED • Payment made based on the reasonable cost of providing the service. Critical Access Hospital

11. Payment Methods

12. Payment Methods • INTERIM PAYMENTS • Payments received periodically (weekly, monthly, etc.) throughout the year via remittance advices. • LUMP SUM PAYMENT • Payment received after computation by Intermediary. • ADVANCE RECOVERY PAYMENT • Payment made by facility to Intermediary after computation by Intermediary.

13. Payment Methods • COST REPORT SETTLEMENT PAYMENT • Payment received from or made to the Medicare or Medicaid Intermediary as a result of the annual cost report settlement computation. • As-Filed Settlement • Tentative Review Settlement • Final Settlement

14. Payment Methods Medicare Lump Sum Payment Example

15. Payment Methods Medicare Cost Report Payment Example (Tentative Review)

16. Payment Methods Medicare Cost Report Payment Example (Final Settlement)

17. Payment Methods Medicaid Cost Report Payment Example (Final Settlement)

18. Medicare Inpatient Bad Debts

19. Medicaid Inpatient

20. Medicare Outpatient Bad Debts

21. Medicaid Outpatient

22. Medicare Cost Reporting Module One: Background Information If you have any questions regarding this course, please contact: Jeff Askey, CPA Draffin & Tucker, LLP P.O. Box 6 Albany, Georgia 31702 (229) 883-7878 JAskey@draffin-tucker.com