Right Place at the Right Time

Flight attendant serving mealTaking an airplane flight involves getting you from one place to another, but where you sit and how much you pay widely varies these days. Some airlines offer first class, business class and coach, while others have only one kind of seating. The in-flight services you receive also vary. First class often receives complimentary drinks, food and other perks that the other sections do not. The overall result is you generally get what you pay for.

In receiving care at a hospital, one sometimes runs into a similar experience. Where you are treated influences the care you receive. If a patient presents in a hospital emergency room (E/R) and needs to have IV fluids infused over four hours, the cost of providing that service is different than if a patient had an IV fluid infusion in an inpatient room (I/P). In the E/R, you might be on a gurney with a curtain drawn around and a nurse gives you the infusion while also looking after four or five other patients. In an I/P room, you get a nice bed in a private room and the nurse may only have one to two other patients.

When the service gets billed to Medicare, there is no difference in how you get paid. But for some hospitals it is important to properly identify the costs on the Medicare cost report.

On the Medicare cost report, the B-2 post stepdown adjustment is designed to help CMS appropriately partition and understand the cost of providing care at a hospital, based on the acuity of the service provided, rather than the location.

Tip #26:

Use a B-2 adjustment when outpatient ancillary services are provided in an inpatient area. (Pub. 15-2, §Section 4022)

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.

 

Payments Can Make or Break You

Marie White

Marie White

“The difference between something good and something great is attention to detail.” Charles R. Swindoll

Medicare pays Acute Care Hospitals for Part A and B services via submitted claims; inpatient is paid under Diagnosis Related Groups (DRGs) and outpatient is Ambulatory Payment Classifications (APCs). Some hospitals can receive added payments for things such as medical education, bad debts, uncompensated care, and others. Medicare will often make additional payments for these items on a periodic basis.

When completing the cost report, it is extremely important to identify the payments you have received on individual claims—these are on a Provider Statistical and Reimbursement (PS&R) report. You also need to include any additional payments you have received for other items. Over- or understating one of these could have a significant impact on the due to/from settlement.

Tip #3:

Confirm and include all pass through and lump-sum payments (Pub 15-2, §4031)

The cost report must include all interim Medicare payments paid on individual bills, pass through payments for services rendered in this cost reporting period.

Further guidance on the types of payments to be disclosed on Worksheet E-1 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.