How to Apply Your Memory Skills in the Matching Game to Cost Reports

From a very early age, the importance of memory and matching is taught, especially through the use of games such as “Concentration.” The game involved flipping over two cards and trying to find a match. If there were no matches, you flipped the cards back down and it was someone else’s turn or you tried two other cards. The simplest versions had pictures of objects and the more complicated might have numbers, words, colors or some combination.

For Medicare cost reporting, the concept of matching is applied to clinical items or services. In preparing your cost report, the expectation is that clinical service expenses, revenues, and associated statistics will be disclosed on the same cost center (or line).

The importance of this is not widely known, but the Centers for Medicare and Medicaid Services (CMS) does use the cost report and related patient claims to develop standard payment rates for inpatient and outpatient services, as well as other reimbursement related items such as outlier adjustments and various indices.

Tip #30:

Ensure costs, charges and statistics are properly matched across the entirety of the cost report worksheets (CMS Pub 15-1, Section 2203).

Further guidance can be found on the Centers for Medicare and Medicaid Services (CMS) website:

Provider Reimbursement Manual 15-1

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

 

The Constitution and CMS Regulations as Foundations: Interpreting Living Documents

US Constitution and FlagIt is generally accepted that the Constitution of the United States is known as a “living document” because its authors intended it to be adapted by future generations. In the past 200 years, the Constitution has been amended 27 times. Additional amendments may be needed in the future. For example, advances in technology may change the way we communicate. Someday, we may be able to vote from our own homes.

The federal regulations that govern the Medicare program can be similarly ascribed as a living document. The regulations themselves don’t change very often, but The Department of Health and Human Services, as well as the Centers for Medicare and Medicaid Services are always interpreting the regulations and issuing guidance in how they apply to health care providers.

Unfortunately, there is no crystal ball to see the future in health care. Therefore, it is often up to the individual hospital to understand and interpret the rules. This is especially true in the evaluation of new services and programs a hospital may choose to offer to its community.

In reviewing a new service, a hospital should use the regulations to provide a framework in deciding whether the new cost center is allowable or non-reimbursable.

Tip #27:

Costs of items or services that bear no relationship to care of hospital patients should be disclosed as non-reimbursable cost centers (Pub. 15-1, section 2328)

Further guidance can be found on the Centers for Medicare and Medicaid Services (CMS) website:

Provider Reimbursement Manual 15-1

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

 

What does a Post Office and a Health Care Organization have in common?

Man sending a letter

The postal service faces what seems to be a monumental task each day. It needs to take piles and piles of mail, identify where each one should go and sort them carefully so they can be sent to the right post office for delivery. How do they make this system work? They have zip codes. These codes help route the mail to the proper local office, regardless of where it originated.

Your coding needs to be properly identified and sorted, too. In health care for the cost report, our zip code equivalent is the Cost Center. Each service is tied to a specific Cost Center, regardless of the different elements of a service. All services need to roll-up to one overall Cost Center when coding.

Tip #21:

If adding a “non-standard” cost center, be sure to select the appropriate cost center code (Pub. 15-2, §Section 4095).

Further guidance can be found on the Centers for Medicare and Medicaid Services (CMS) website.

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