New Year’s Uber Rides and SNF Contracted Personnel

Man Using the Uber Taxi App on Iphone in NYC

This week’s tip is for the Skilled Nursing Facility (SNF) folks, but also has relevance to hospitals.

Each New Year’s Eve, there is demand for taxis—and now Uber drivers—to safely transport revellers home .This year, it was reported that Uber prices surged by nearly 10X during peak times (between midnight and 3:00 a.m.) following celebrations.

A similar situation exists for health care providers and the demand for their services. With the current strong economy, it has become a huge challenge for SNFs and hospitals to find personnel to provide necessary services to residents and patients. People have their choice of employer and locations in this competitive environment. Health care providers often have to resort to using contract nurses and other professionals who may have to travel several hours to a facility. In addition to an hourly wage, the facility may have to pay mileage, hotel and other travel costs to the contractor or an agency.

CMS recognizes that contracted personnel is a necessary and allowable expense, but there are further rules that govern what can be included for wage index computations (see Tips# 4 & 8 for further insight on wage index).

Tip #24:

SNF contracted personnel costs should not include miscellaneous items, such as travel or supplies expense. (Pub. 15-2, §4105.1).

Further guidance 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


What are SNF Swing Bed Days?

Male smartphone app car park Vintage filter


To some people, these abbreviations make no sense, but to most who send text messages they are easy to understand (“laughing out loud,” “be right back,” and “talk to you later”).


To someone who works in health care, these abbreviations are the ones that make sense, but unfortunately knowing what the abbreviation stands for doesn’t always help you understand what it truly means (“average length of stay,” “skilled nursing facility,” and “Magnetic resonance imaging”).

For the Medicare cost report, skilled nursing facility (SNF)-type services are routine services furnished by a swing-bed hospital that would constitute extended care services if furnished by an SNF. Effective October 1, 1990, only Medicare covered services are included in the definition of SNF-type services.

Services in swing bed areas provided to Medicaid and other non-Medicare payers are considered “nursing facility” (NF) days and are reported and paid differently than SNF days

Tip #16:

“Skilled” Swing Bed days are the only days Medicare considers “SNF” for the Cost Report (Pub. 15-2, §Section 4005.1).\

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

Provider Reimbursement Manual 15-2, Chapter 40

Questions? Please contact Marie White at 612.253.6546 or

Wage Index: Defining It and Understanding Yours

Most everyone knows the saying, “Keep your friends close and your enemies closer.” In the world of health care, we don’t really have enemies per se, but we definitely have competitors. It is important to stay in touch with competitors for various reasons, such as:

  • You may benefit from understanding their perspective and/or ideas on a subject
  • You may need to work together someday
  • You may have shared interests if you dig deep enough

A practical application of this concept is the wage index. The index is an adjustment for differences in hospital wage rates among labor markets. It is computed using individual hospital data that is then compared to metropolitan statistical area (MSA) or statewide rural area to the nationwide average.

Since the inception of a Prospective Payment System (PPS) for Skilled Nursing Facilities (SNF), hospital wage data has been used to develop a wage index to be applied to SNFs. The SNF PPS wage index values for any fiscal year are calculated from the same data used to compute that fiscal year’s acute care hospital inpatient wage index data.

Tip #8:

Educate yourself on what your own wage index ratio is and how it compares to your marketplace, your state and the national average.

You should also consider establishing a task force among the hospitals and SNFs in your area to analyze how each other are reporting their wage data and if there are ways you can enact change that would result in an improved index.

Guidance is available on the Centers for Medicare and Medicaid Services (CMS) website:

Medicare Wage Index home page

Questions? Please contact Marie White at 612.253.6546 or



Worksheet S-2: Know Your Facility

Marie White

Marie White

In the words of the famous philosopher Aristotle, “The more you know, the more you know you don’t know.” This quote couldn’t be more appropriate for cost reports.

The Centers for Medicare and Medicaid Services (CMS) generally publishes regulations and notices on the fourth Friday of each month. In 2015, this amounted to more than 200 notices, so keeping up is somewhat of a challenge!

One thing that may make it easier to stay current with the changes is a better understanding of your own facility. The cost report includes a Worksheet S-2 that has various questions about your facility and if you can develop an understanding of these, it could help you know when a newly published regulation has a potential impact on you.

Tip #2:

Confirm all S-2 questions are answered properly (Pub 15-2, §4004)

Worksheet S-2 includes Part I (171 questions) and Part II (43 questions) and the corresponding instructions encompass twenty-seven pages; the entire instructions are 500+ pages so some “light reading” when you have some free time. Separate instructions exist for SNFs (Chapter 41) and Hospice (Chapter 43).

The instructions are available on the CMS website:

Provider Reimbursement Manual 15-2

Questions? Please contact Marie White at 612.253.6546 or