Georgia Medicaid DSH Audit Training October 29 th , 2009

1. Georgia MedicaidDSH Audit TrainingOctober 29th, 2009 Jim Erickson, Member Myers and Stauffer LC

2. Training Overview • Update on 2005 & 2006 DSH Audits • Review of DSH Data Requirements for DSH Audit and Payment Processes • Review of the Medicaid DSH Survey Tool • Questions and Answer Session

3. Update on 2005 & 2006 DSH Audits • Submitted Surveys are Currently being reviewed • Select hospitals will be contacted for additional verification through field audits • Likely scheduled for January • Will involve1-2 days of field work depending on hospital size

4. Update on 2005 & 2006 DSH Audits • Additional Guidance from CMS • Reports will not be considered out of compliance if delivered to states by 9/30/10 and to CMS by 12/31/10 • States must still be making an effort to complete and provide updates to CMS • Data • Reports and Audits should be based on the best available information • Goal is for states to accurately report on these elements by the end of the transition period (SFY 2011)

5. Questions/Comments?

6. DSH Data Requirements Audit & Payment • Audit requirements created specific definitions for uncompensated care costs • Definition of uninsured • Costing Methodology • Differed from previous payment definitions and cost methodology • Use a single survey document to collect data for both uses • Get back to an annual survey that will satisfy both purposes

7. DSH Data Requirements Audit & Payment • 2005 & 2006 DSH Audit (Surveys Done) • Collected data from cost reports that cover: • 7/1/04 – 6/30/05 (SFY ‘05) • 7/1/05 – 6/30/06 (SFY ‘06) • 2007 DSH Audit • Collect data from cost reports that cover: • 7/1/06 – 6/30/07 (SFY ‘07) • 2010 Payment • Cost reports ending in 2008

8. DSH Data Requirements Audit & Payment • Example Provider with 12/31 Fiscal Year: Cost Report Periods 1/1/04 – 12/31/04 1/1/05 – 12/31/05 1/1/06 – 12/31/06 1/1/07- 12/31/07 1/1/08 – 12/31/08 Done Done Done Need to Make 2010 DSH Payments SFY ‘05 DSH Audit SFY ‘06 DSH Audit SFY ‘07 DSH Audit SFY ‘08 DSH Audit 2010 DSH Payment

9. Questions/Comments?

10. Medicaid DSH Surveys (2007 Audit / 2010 Payment) General Instruction and Identification of Cost Report Years • Select your hospital from the drop-down menu • Verify provider number is correct • DSH year begin and end dates will populate • Identify the cost report years needed to completely cover DSH year Example: DSH year 7/1/06 thru 06-30-07 Cost report years needed: 1-1-06 thru 12-31-06*, and 1-1-07 thru 12-31-07 * - If the hospital received a SFY ‘06 DSH payment and completed the 2006 DSH audit survey this would already be reported so 12/31/07 would be the only cost report to report on.

11. Medicaid DSH Surveys (2007 Audit / 2010 Payment) General Instruction and Identification of Cost Report Years • Answer survey questions (4-6 on ‘07 Audit Survey, 6-8 on ‘10 Payment Survey) to determine if hospital is eligible to receive DSH payments • Supporting documentation for all DSH survey responses must be maintained by your hospital (for a minimum of 5 years)

12. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section A – Cash Subsidies and Charity Care Charges • The state must report your actual MIUR and LIUR for the DSH year - data is needed to calculate the LIUR • Provide the amounts for each cost report year needed to cover the DSH year • If cash subsidies are specified for I/P or O/P services, record them as such, otherwise record entire amount as unspecified

13. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section B – Out of State Medicaid Provider Numbers • List your Medicaid provider names and numbers for states other than Georgia • If more lines are needed than provided on the form, attach a complete list to your survey

14. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section C – Net hospital revenue from patient services • Information is needed to determine your actual LIUR for the DSH year. A separate schedule must be used for each cost report year covering a portion of the DSH year. • Data elements used in calculation are: • Inpatient hospital charges • Net hospital revenue Note: The form provides space to allocate contractual allowances among service centers. If such an allocation is not reasonable, record a single amount for hospital services and a single amount for non-hospital (i.e., hospital-based skilled nursing facility, home health agency, etc.) services

15. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section D – Calculation of Medicaid and Uninsured Costs (Using Cost Report Methods) • For each cost report covering a portion of the DSH year, the hospital should record the routine per diem costs and ancillary cost-to-charge ratios for each cost center. Use cost report schedules D-1 and C for these values • Enter inpatient (routine) days, I/P and O/P ancillary charges. The form will calculate cost for: • In-State FFS Medicaid (from Medicaid (HS&R) • In-State Managed Care (from Hospital Records) • In-State FFS Cross-Over (from Hospital Records) • In-State Managed Care Cross-Over (from Hospital Records) • Payment data should agree to HS&R (or paid claims report from MMIS) reports from Medicaid and/or hospital internal records

16. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section D – Calculation of Medicaid and Uninsured Costs (Using Cost Report Methods) • For uninsured services, patient days (by routine cost center) and ancillary charges by cost center are needed • Survey form Exhibit A shows the data elements that need to be collected and provided to Myers and Stauffer. This data will allow us to cost your uninsured services using cost report mechanics • Uninsured services need to be identified for each cost reporting period covering a portion of the DSH year.

17. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section D – Calculation of Medicaid and Uninsured Costs (Using Cost Report Methods) • Payment received for uninsured services need to be reported on a cash basis • For example, a cash payment received during the ’07 DSH year (7-1-06 thru 6-30-07) that relates to a service provided in calendar 2004, must be used to reduce uninsured cost for the ’07 DSH year • Survey form Exhibit B has been designed to assist hospitals collect and report uninsured payments received data • DSH hospitals should make a reasonable effort to identify insurance status when care was provided for all patient payments received during the DSH year. If service dates are so outdated that insurance status cannot be identified, report these cash collections on Exhibit B-1. Payment will be allocated between insured and uninsured using your collection stat during the time period when insurance status could be identified

18. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section D – Calculation of Medicaid and Uninsured Costs (Using Cost Report Methods) • Uninsured Services: Uninsured patients are individuals with no source of third party health care coverage (insurance). If the patient had health insurance, even if the third party insurer did not pay, those services are insured and cannot be reported as uninsured on the survey

19. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section E – Out of State Medicaid Services • Medicaid days, ancillary charges and payments received must be reported on this section of the survey. The cost and payments for another state’s Medicaid services are included in your hospital’s uncompensated care costs • The data needed should be reported in the same format as data on Section D. Days, charges and payments received must agree to the other state’s HS&R (or similar) claim payment summary • If your hospital provided services to several other states, please consolidate your data and provide detailed support for your survey responses

20. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section F & G – Transplant Hospital Organ Acquisition Costs • These schedules should be used to calculate organ acquisition cost for Medicaid (in-state and out-of-state) and uninsured • Report data for each cost report year needed to cover the DSH year • Summary claims data (HS&R) or similar documents and provider records (organ counts) must be provided to support the charges and usable organ counts reported on the survey

21. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Section H – Section 1011 and Out of State DSH Payments • Section 1011 provides reimbursement for emergency health services furnished to undocumented aliens. Because a portion of the payments are made for cost recognized for DSH, a portion of these payments must be recognized on behalf of uninsured hospital services • You must report your Section 1011 payments included in payment on Exhibit B (posted at the patient level), received but not included in Exhibit B, and separate the 1011 payments between hospital services and non-hospital services (non-hospital services include physician services) • If your facility received DSH payments from another state (non-Georgia DSH payments), these payments must be reported on this section of the survey • Report any Medicaid supplemental payments made based on the state fiscal year.

22. Medicaid DSH Surveys (2007 Audit / 2010 Payment) Certification • Answer the question addressing if your hospital was allowed to retain 100 percent of the DSH payments it received. Providing IGT/CPE funding is not the basis for a no answer • The hospital’s CEO or CFO must certify as to the accuracy and completeness of your survey responses • Provide contact information for person(s) responsible for completing survey

23. Other Information: Please use the DSH Survey Submission Checklist Send survey and other data to: Myers and Stauffer LC Attn: Georgia DSH Survey 11440 Tomahawk Creek Parkway Leawood, Kansas 66211 Questions: Phone: (800) 374-6858 e-mail: gadsh@mslc.com

24. Questions/Comments?