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Author Archive for: ‘Medicare Cost Report’

  • The Importance of Medicare Cost Report Compliance

    We know that CMS requires the Medicare Cost Report as a condition of payment, but we should also note the basic principle of Medicare Cost Report filing. See 42 C.F.R. s. 413.24. The overarching principle reads: “Providers receiving payment on the basis of reimbursable cost …

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  • Changes to Critical Access Hospitals

    If you don’t know yet, there are some contemplated changes to CAHs (Critical Access Hospitals). Here’s a rundown of CAH’s basic requirements: The problem is that if these providers were forced to re-certify, they may not meet the rural requirement or the distance requirement. There …

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  • Excess Readmissions Continued

    I briefly discussed the impact of the readmission calculation before. Now, I came across an excellent summary paragraph from the authors themselves: The proposed ratio is a measure of relative performance. If a hospital performs better than an average hospital that admitted similar patients (that …

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  • Minimum Data Set (RAI) Manual and the SNF Medicare Cost Report

    For those involved with SNFs are are interested in reading more about the MDS, I found a helpful website that organizes the MDS quite well. If you would like to more about ADLs, RUGs, clinical assessments, and more, you may find the MDS content quite …

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  • Routine v. Ancillary v. Capital costs

    I came across a clear distinction between these areas of costs in a 1998 Federal Register entry implementing the SNF PPS. It states: In general, routine costs are the costs of those services included by the provider in a daily service charge. Routine service costs …

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  • CMS Final Rule 2014

    FY Final Rule for 2014 has been release here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2014-IPPS-Final-Rule-Home-Page-Items/FY-2014-IPPS-Final-Rule-CMS-1599-F-Regulations.html?DLPage=1&DLSort=0&DLSortDir=ascending. Looks like there are changes to the wage index, GME, IME, and more implementation of the ACA. Updates wll follow soon.

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  • Medicare Readmission Reduction Calculation

    I came across a simple explanation of how CMS will calculate readmission reduction payments. Remember that the reduction applies to 3 categories: heart failure, acute myocardial infarction, and pneumonia. First, CMS tells us that the reductions are calculated using the excess readmission ratio, which is …

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  • Prior to the SNF Medicare Cost Report: Skilled Nursing Facility (SNF) Eligibility

    To understand the SNF cost report, we have to understand SNF eligibility requirements. What is the criteria for SNF eligibility? We find some help in 42 C.F.R. 409.31, which provides the following: For SNF cost report preparation or SNF cost report software, please visit our …

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  • Continued Benefits of Medicare DSH Payments

    Here is a brief explanation of how providers will be hit with adjustments to the Medicare DSH calculation: For more information, head over to http://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/dsh.html

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  • PS&R Reimbursement for your Medicare Cost Report Software

    For those interested in finding, renewing, expanding, or changing your Medicare cost report software provider, you may wish to determine whether the software contains a PS&R import. The advantage of this feature is that your charges will be automatically imported without the need for additional …

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