MCR Forms Changes October 11, 2018 Presented by Eric Swanson Overview • Agenda • 2019 IPPS Final Rule • Transmittal Changes • Questions 10/1/2018 2 FFY 2019 IPPS PROPOSED RULE 10/1/2018 3 FFY 2019 IPPS FINAL RULE • Supporting documents: • Teaching hospitals‐‐For teaching hospitals, the Intern and Resident Information System (IRIS) data. • Bad debt‐‐Effective for cost reporting periods beginning on or after October 1, 2018, for providers claiming Medicare bad debt reimbursement, a detailed bad debt listing that corresponds to the amount of bad debt claimed in the provider’s cost report. • DSH eligible hospitals‐‐Effective for cost reporting periods beginning on or after October 1, 2018, for hospitals claiming a disproportionate share hospital payment adjustment, a detailed listing of the hospital’s Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the hospital’s cost report. If the hospital submits an amended cost report that changes its Medicaid eligible days, the hospital must submit an amended listing or an addendum to the original listing of the hospital’s Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the hospital’s amended cost report. • Charity care and uninsured discounts‐‐Effective for cost reporting periods beginning on or after October 1, 2018, for DSH eligible hospitals reporting charity care and/or uninsured discounts, a detailed listing of charity care and/or uninsured discounts that corresponds to the amounts claimed in the DSH eligible hospital’s cost report. • Home Office (Next Slide). 10/1/2018 4 FFY 2019 IPPS FINAL RULE • Supporting documents: • Home office cost allocation. 1. Same fiscal year end. Effective for cost reporting periods beginning on or after October 1, 2018, for providers claiming costs on their cost report that are allocated from a home office or chain organization with the same fiscal year end, a Home Office Cost Statement completed and submitted by the home office or chain organization to its chain provider’s servicing contractor that corresponds to the amounts allocated from the home office or chain organization to the provider’s cost report. 2. Differing fiscal year end. Effective for cost reporting periods beginning on or after October 1, 2018, for providers claiming costs on their cost report that are allocated from a home office or chain organization with a different fiscal year end, a Home Office Cost Statement completed and submitted by the home office or chain organization to its chain provider’s servicing contractor that corresponds to some portion of the amounts allocated from the home office or chain organization to the provider’s cost report. 10/1/2018 5 Transmittal Updates Form Type Latest CMS HFS HFS Effective Transmittal Issued Approved Released Date 2552‐10 Hospital 14 3/16/2018 4/6/2018 4/13/2018 2540‐10 SNF 8 3/9/2018 3/29/2018 4/6/2018 216‐94 OPO 7 10/6/2017 3/29/2018 4/16/2018 1728‐94 HHA 18 3/16/2018 4/6/2018 4/13/2018 265‐11 ESRD 4 2/16/2018 4/6/2018 4/13/2018 224‐14 FQHC 4 3/9/2018 4/17/2018 4/17/2018 1984‐14 Hospice 3 4/13/2018 4/20/2018 4/26/2018 Recent Publications 222‐17 RHC 1 5/18/2018 9/7/2018 10/26/2018 Ending on or after 9/30/2018 2088‐17 CMHC 1 5/18/2018 8/24/2018 10/26/2018 Ending on or after 9/30/2018 No Recent Changes 287‐05 HO 10/1/2018 6 2552‐10 T‐14 • Hospital Transmittal 14 • CMS issued Transmittal 14 on March 16, 2018 • HFS was approved by CMS for Transmittal 14 on April 6, 2018 • HFS released Transmittal 14 on April 13, 2018 • Effective Date ‐ Cost Reporting Periods Ending on or After January 31, 2017 This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS‐2552‐10), by accommodating select provisions of the Bipartisan Budget Act of 2018, and the Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Final Rule. This transmittal also updates Chapter 40 by clarifying and correcting the existing instructions as well as incorporating additional statutory and regulatory changes. 10/1/2018 7 2552‐10 T‐14 (Specific Changes). • Worksheet S‐2, Part I: • Modified the instructions for Worksheet S‐2, Part I, line 39 to reflect the extension of the inpatient hospital adjustment for low‐volume hospitals for discharges occurring through FY 2018. 10/1/2018 8 Adjustment for Low Volume Hospitals • Section 50204 of the Bipartisan Budget Act of 2018 Modified LVA • For FY 2018 Extended • More than 15 miles from another subsection (d) hospital • Less than 1,600 Medicare discharges • Sliding scale adjustment factor • For FY 2019 – 2022 • More than 15 miles from another subsection (d) hospital • Less than 3,800 Total discharges • Based on most recently submitted cost report • Sliding scale adjustment factor • 25% for 500 or fewer • For FY 2023 reverts to pre FY 2011 10/1/2018 9 2552‐10 T‐14 (Specific Changes). • Worksheet S‐2, Part I: • Clarified the instructions for Worksheet S‐2, Part I, lines 61 – 61.06 as the ACA section 5503 evaluation period requirements expired July 1, 2016. 10/1/2018 10 2552‐10 T‐14 (Specific Changes). • Worksheet S‐3, Part I: • Opened Worksheet S‐3, Part I, line 33, column 13 for the reporting of discharges associated with non‐covered LTCH Medicare days. 10/1/2018 11 2552‐10 T‐14 (Specific Changes). • Worksheet S‐10: • Clarified the instructions for Worksheet S‐10 lines 28 and 29. 10/1/2018 12 2552‐10 T‐14 (Specific Changes). • Worksheet E, Part A: • Clarified the instruction for Worksheet E, Part A, line 8.01 as the ACA section 5503 evaluation period requirements expired July 1, 2016. • Updated the instructions to Worksheet E, Part A, lines 48 and 49 to reflect the extension of the Medicare‐ dependent hospital (MDH) program through September 30, 2022, in accordance with the Bipartisan Budget Act of 2018, §50205. 10/1/2018 13 2552‐10 T‐14 (Specific Changes). • Worksheet E‐4: • Clarified the instruction for Worksheet E‐4, line 4.01 as the ACA section 5503 evaluation period requirements expired July 1, 2016. 10/1/2018 14 2552‐10 T‐14 (Specific Changes). • Worksheet O and O‐1 ‐ O‐4: • Added a line 42.50 to report the costs of drugs furnished to individual patients. 10/1/2018 15 2552‐10 T‐14 (Specific Changes). • New Edits • If Worksheet S‐2, Part I, line 60, column 1=“Y”, then line 60.01 and subscripts, columns 2 and 3, must be present. [09/30/2017] 10/1/2018 16 2552‐10 T‐14 (Specific Changes). • New Edits • 10710S If the CCN on Worksheet S‐2, Part, I, column 2, line 3, is XX‐4000 through XX‐4499 (freestanding IPF), then Worksheet B, Part I, column 26, lines 60 and 73, must be greater than zero. [09/30/2017] • Required separate reporting of LAB and Drugs Charged to Patients for IPF providers • Was hitting many all‐inclusive rate State IPF facilities • Bringing back for FYE on or after 8/31/2018 excluding all‐ inclusive rate providers. 10/1/2018 17 2552‐10 T‐14 (Specific Changes). • New Edits • 14005S Worksheet S‐10, line 20, column 3, must be less than Worksheet C, line 200, column 8. If Worksheet S‐2, Part I, line 115, column 1, is “Y”, do not apply this edit. [10/01/2013b] Edit created issues for all‐inclusive providers. 10/1/2018 18 2552‐10 T‐14 (Specific Changes). • Clarified Edits • 14006S Worksheet S‐10, line 20, column 2, must be greater than or equal to line 25. [10/01/2013b] • 14015S If Worksheet S‐10, line 27.01, is greater than zero, then line 26 must be greater than or equal to line 27.01, and line 27 must be less than 27.01. [10/01/2013b] 10/1/2018 19 2552‐10 T‐14 (Specific Changes). • Revised Edits • 10540D Worksheet D‐5, column 1, may only contain Worksheet A line numbers 4 through 41, 43, 50 through 77, 90 through 99, 105 through 111, 115, and subscripts as allowed. [05/01/2010b] • Used to apply to A‐8‐2, now will only apply to Worksheet D‐5 (Apportionment of Costs for Physicians’ Services in a Teaching Hospital) 10/1/2018 20 2552‐10 T‐14 (Specific Changes). • New Edits • 10830E If Worksheet E‐4, line 6, or line 8, column 3, is greater than zero, then both lines must be greater than zero, and line 8, column 3, must be less than or equal to line 6. [01/31/2018] 10/1/2018 21 2540‐10 T8 • SNF Transmittal 8 • CMS issued Transmittal 8 on March 9, 2018 • HFS was approved by CMS for Transmittal 8 on March 29, 2018 • HFS released Transmittal 8 on April 6, 2018 • Effective Date ‐ Cost Reporting Periods Ending on or After December 31, 2017 • The primary purpose of Transmittal 8 was the incorporation of a Worksheet S, Part II, check box to the certification and settlement summary statement for electronic signature submission to the Skilled Nursing Facility cost reporting forms. This provision is available as an option for cost reporting periods ending on or after 12/31/2017 in accordance with 42 CFR 413.24(f)(4)(iv). 10/1/2018 22 2540‐10 T8 (continued) • Worksheet S • Part I –No Utilization • CMS added Worksheet S, Part I, line 3.01 to accommodate the reporting of a No Utilization Cost Report • The MAC may verify 10/1/2018 23 2540‐10 T8 (continued) • Worksheet S‐2, Part I • Line 19 Low Utilization • Requires prior approval • The MAC may verify 10/1/2018 24 2540‐10 T8 (continued) • Worksheet S • Part II modified for Electronic Signature 10/1/2018 25 2540‐10 T8 (continued) • New Edits • Wage Index Data Accuracy 1115S All amounts on Worksheet S‐3, Part II and III, column 3, must be equal to or greater than zero.