Presentation Transcript

1. Affordable Care ActSection 3133 Medicare DSH HFMA Education Session # 3 February 21, 2013 Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) payments. Presented by: Paul Bouganim Principal Financial Analyst Cedars-Sinai Medical Center
2. Agenda New DSH Formulas and Projections Wkst S-10 and Charity Care CMS National Provider Call, January 8, 2013 – Donna Anglin, 2552PROplus, LLC. Legal Update and Data Sources – John R. Hellow, Hooper Lundy & Bookman, Inc.
3. DSH Payment Formula Effective FY 2014(Discharges on/after 10/01/13) Base DSH Payment 25% of DSH payment computed under existing law – 42 CFR 412.106 Plus Add-on Payment - Product of three factors: Factor 1 = 75% of national aggregate DSH payments under existing law Factor 2 = A measure of the percentage change in the uninsured population age < 65 since 2013 (FY, CY)? Factor 3 = A hospital specific percentage of national aggregate charity care
4. DSH Payment Formula Effective FY 2014(Discharges on/after 10/01/13) Add-on Payment: Factor 2 = A measure of the percentage change in the uninsured population age < 65 since 2013 (FY, CY)? 1 minus the % change from 2013 to “most recent period” minus 0.1% in 2014 and minus 0.2% in 2015 through 2019 Factor 3 = A hospital specific percentage of national aggregate charity care Period not specified by Section 3133; left to Secretary to select period
5. Let’s Take a Look… (-0.2% for FY2015 to FY2019)
6. Huge Impact
7. Charity Care and Wkst S-10 – Nothing Ties! Financial Statements IRS Form 990 Worksheet S-10 OSHPD Medicare
8. Charity Care and Wkst S-10 Financial Statements Traditional Charity Care Unpaid cost of Medicaid* Unpaid cost of Medicare Research Other Community Benefits IRS Form 990 (Schedule H) Traditional Charity Care Unpaid cost of Medicaid* Unpaid cost of Medicare Research Other Community Benefits *Including State/Local Government Programs Consolidated Financials Medical Center Only Excludes GME Different Community Benefits
9. Charity Care and Wkst S-10 Medicare (2552-10, Wkst S-10) Traditional Charity Care Unpaid cost of Medicaid* Non-Medicare Bad Debts OSHPD Traditional Charity Care Reported at gross charges *Including State/Local Government Programs Likely to be the default definition of Charity Care for DSH, maybe… S-10 Also Used for EHR Incentive Payments!
10. Bonus Slide: (b) Medicare Share: IP Part A Days + IP Part C Days ÷ Total IP Days x [ (Total Charges - Charity Care Charges) ÷ Total Charges ]
11. Charity Care and Wkst S-10 Unpaid Cost of Medicaid Overall Facility Cost-to-Charge Ratio, Wkst C, Part I Gross Medi-Cal and Medi-Cal HMO Charges (Provider Records)
12. Charity Care and Wkst S-10 Traditional Charity Care Gross Charges Internal Report of all Accounts with Charity Code Write-Off Separated between Accounts w/ Insurance Pmt and w/o Insurance Pmt Any payments posted to account are offset Charity Write-Off: Formal application and approval for Charity Care EHR!
13. Charity Care and Wkst S-10 Non-Medicare Bad Debt Non-Medicare Bad Debt End Game: Unpaid Medicaid: $65,178,384 Traditional Charity Care: $52,438,879 Non-Medicare Bad Debt: $51,105,059 $168,722,322 Ln 30 for DSH? Charity + Bad Debt Only