Claims Data is “Big Data”

Marie White

Marie White

One of the new buzzwords these days is “big data.” But what exactly is big data? According to the fine folks at Wikipedia, “big data is a broad term for data sets so large or complex that traditional data processing applications are inadequate.” In the world of Medicare, big data is claims data.

Medicare Part A and B claims are processed by the Centers for Medicare and Medicaid Services (CMS) and then summarized in a document called the Provider and Statistical Reimbursement (PS&R) Summary Report. Each provider is responsible for requesting this summary report when the annual cost report is prepared.

The PS&R system has numerous reports that may be generated in addition to the summary report. Payment Reconciliation Reports (also known as Detail Reports) contain detailed, claim-specific data that supports the summary reports.

Providers are permitted to request detail reports, which can be analyzed and compared to internal data and help you better understand the Medicare reimbursement you are receiving.

Tip #6:

Ensure you have access to the PS&R system and are familiar with the steps to request a report.

Users must have an ID and password to access the system. Apply early, as there’s an approval process to obtain these.

Guidance is available on the CMS website:

PS&R Provider Community

Questions? Please contact Marie White at 612.253.6546 or mewhite@eidebailly.com.

 

Documentation: “If a Tree Falls . . .”

“If a tree falls in a forest and no one is around to hear it, does it make a sound?”

Marie White

Marie White

One of the most challenging issues in health care is documentation. Like the above quote, it’s become somewhat of a cliché, but nevertheless it’s true: if you didn’t document it, you didn’t do it or it didn’t happen. This mantra is equally important for services you provide to patients, as well as services you purchase from others.

The hospital must ensure that supporting documentation for both salaries and hours are based on actual data maintained in a form that permits validation by the contractor. The use of estimates for these amounts is unacceptable for the wage index.

Tip #5:

When reporting contract labor for wage index, ensure you have hours to match expense (Pub 15-2, §4005.2)

Further guidance on the types of hours that should be included on Worksheet S-3, part II can be found on the Centers for Medicare and Medicaid Services (CMS) website:

Provider Reimbursement Manual 15-2

Questions? Please contact Marie White at 612.253.6546 or mewhite@eidebailly.com.