Positively Impact Your Hospital’s Payment Stream with DSH

With all the recent changes in health insurance, it would be simple to assume that how much a hospital will be paid is out of its control. But there are still some opportunities for a hospital to potentially impact its payment stream from Medicare in a positive way. 

For some Prospective Payment System (PPS) hospitals there is an additional funding mechanism to pay for “disproportionate share” (DSH). DSH is funding to hospitals that treat indigent patients under which facilities are able to receive at least partial compensation. The dollars paid are determined using a formula that includes several factors which are determined by the individual hospital and by CMS.

A hospital can influence its own factor by monitoring and reviewing patient days to ensure it is capturing all days that are permitted by the regulations.

Tip #18:

Review DSH percentage for accuracy and confirm appropriate amounts under the new payment methodology.

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

Disproportionate Share Hospital (DSH)

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.