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Category Archive for: ‘Medicare Reimbursement’

  • Medicare Cost Report Worksheet B, Part 1: Step-Down Process

    I’d like to use this post to briefly explain the step-down process on the Medicare cost¬† report 2552-10, but which is applicable on other Medicare and Medicaid cost reports.¬† For example, it is used on the Skilled Nursing Facility cost report and Home Health Agency …

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  • 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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  • 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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  • 340B Pricing: How Your Disproportionate Patient Percentage Affects Pharmacy Costs

    We have spoken a bit about Disproportionate Share Payments in a prior post. We established in that post that your disproportionate patient percentage may increase your Disproportionate Share payments. What we didn’t mention is that the DPP can also benefit you on pharmacy costing. There …

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  • Physician Time Studies for Medicare/Medicaid Cost Reports

    For those of you struggling to calculate the impact of physician time studies, let me first outline where the physician time studies are used on the Medicare cost report. If you refer to the A-8-2 on the 2552-10, you will find that the instructions state …

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  • Importance of Cost Basis on the B-1 (2552-10) of the Medicare/Medicaid Cost Reports

    The A-series worksheets identify the costs your facility is prepared to report on the Medicare and Medicaid cost reports. First, we start with the trial balance (A), continue to reclassification (A-6), detailing (A-7), and then go to adjustments (A-8/A-8-2). What happens next? At this point …

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