REIMBURSEMENT SERVICES | FINANCIAL REPORTING | OTHER SERVICES
Hospital Management Services (HMS) has been providing Medicare cost report preparation services to Acute Care Hospitals, Skilled Nursing Facilities for over 40 years. Since 1969, HMS has provided services to over 175 acute and skilled nursing hospitals, ranging in size from 13 beds to 2000 beds where the facility complexity ranges from the simple general acute hospital to one providing an all encompassing range of daily nursing and diagnostic services and interns & residents programs .
MEDICAID (MEDI-CAL in California)
Hospital Management Services (HMS) has been providing Medi-Cal cost report preparation services to California Acute Care Hospitals, Skilled Nursing Facilities , Home Health Agencies, and Renal Dialysis Centers since the near start of the program. Our expertise can help a client with monitoring the complex relationships encountered when non-contracting with Medi-Cal, where the client has financial exposure from a “cost based” reimbursement relationship that is subject to caps through Maximum Inpatient Reimbursement Limitation (MIRL) and Peer Group Inpatient reimbursement Limitation (PIRL) requirements and the collateral impact to Medicare disproportionate share hospital (DSH) when non-contracting options are used. For the contracting facility our expertise gives us the ability to help clients monitor the costs benefits from operating their facility to the ever increasing pressure of providing care to a growing under-insured / un-insured patient population.
HMS has been preparing the Office of Statewide Health Planning and Development (OSHPD) Annual Disclosure Reports for Acute Hospitals and the Long Term Integrated Disclosure Report and Medi-Cal Cost Report for Skilled Nursing Facilities since the beginning of these programs.
The beginnings of this California Program started under then Governor Ronald Reagan through Senate Bill 283, signed into law on October 26, 1971 that created the California Hospital Commission. On March 17, 1973 the Commission adopted regulations to begin the Hospital Disclosure Act requiring acute hospitals in the State to adopt a uniform accounting and reporting system and to begin reporting to the Commission for all fiscal years starting on or after January 1, 1974. In 1974 the Commission, since named the California Health Facilities Commission (CHFC) expanded its jurisdiction to include all Skilled Nursing Facilities in the State of California to begin using a uniform system of accounts and standardized reporting beginning with fiscal years ending on or after January 1, 1977. In the 1983 – 1984 legislative session, Senate Bill 181 was signed into law by then Governor George Deukmejian which is known as the Health Data and Advisory Council Consolidation Act. This act recognized that CHFC would sunset on January 1, 1986 and transfer all of its functions to the Office of Statewide Health Planning and Development (OSHPD). HMS has extensive experience in assisting clients prepare and file the required annual reports and in the development of mandated systems of accounts for a conversion in the GL system and/or crosswalks between accounting systems mandated by corporate office and the State of California required system of accounts. The OSHPD Annual Disclosure report for acute facilities is a crucial component of the Medi-Cal DSH entitlement program. HMS can assist facilities with correcting data used in the Medi-Cal DSH calculation and insure the amount of reimbursement is correct and proper.
Wage Index Data reviews have become a significant item of the annual audit of a cost report by the Medicare program. Accurate and complete data along with a timely and efficient response to these audit requests is a critical component toward keeping the Wage Index Factor updated to the current structure of hourly wages paid in your facility. This is one of the few remaining areas of a Medicare audit that can actually have a direct affect on future Inpatient (IPPS) reimbursement from the Medicare program. HMS has extensive experience in these audits, making available to our clients awareness of efficient, timely and proven processes of providing detailed information to the Medicare audit staff.
OCCUPATIONAL MIX SURVEY
Another key area of audit by Medicare when reviewing the wage related data from a cost report is the Occupational Mix Survey. This can be a frustrating component of an audit as typically the Wage Index audit of a prior fiscal year is conducted simultaneously with the Occupational Mix Survey which covers the fiscal period beginning July and ending June of a more current period and unless your fiscal year is June ending it will require your staff to collect payroll information for a 12 month period alien to your normal annual accounting period. This review is further complicated by the fact that response times allowed to collect and submit data back to the auditor are typically very short (can be 30 days or less) and do not allow for extensions. HMS can provide valuable guidance during the audit process allowing for a more efficient and timely response to the Occupational Mix Survey inquiry.
TRICARE / CHAMPUS CAPITAL AND DIRECT MEDICAL EDUCATION COSTS REIMBURSEMENT REQUESTS
TRICARE/CHAMPUS authorizes hospitals that provide health care services to TRICARE/CHAMPUS patients (Military dependents, retirees and active duty personnel) to be reimbursed for allowed capital and/or Direct Medical Education costs. Reimbursement is subject to the following regulations as outlined in the TRICARE/CHAMPUS policy manual:
1. Any hospital subject to the TRICARE/CHAMPUS DRG-based payment system which wishes to be reimbursed for Allowed Capital and Direct Medical Education costs must submit a request for reimbursement to the TRICARE/CHAMPUS Contractor.
2. The initial request must be submitted on or before the last day of the twelfth month following the close of the hospital’s cost-reporting period. The request must correspond to the hospital’s Medicare cost-reporting period (dates and costs). Hospitals must submit their request forms and applicable pages from their Medicare Cost Reports to the TRICARE Contractor.
The description and instructions for completing the TRICARE/CHAMPUS request for reimbursement forms is located in the TRICARE/CHAMPUS Reimbursement Manual, Chapter 6, Section 8. HMS can assist in the preparation of the reimbursement requests with TRICARE/CHAMPUS
On September 29, 2004 Assembly Bill AB-1629 was signed into law enacting the Medi-Cal Long Term Care Reimbursement Act. This bill directs the California Department of Healthcare Services (CDHS) to obtain Federal approval of a cost-based, facility specific rate setting system for freestanding nursing providers beginning on August 1, 2005. This law further states these provisions are to be implemented on the first day of the month following the approval of the plan by CMS.
To comply with this regulation CDHS requires two supplemental schedules to be completed and filed electronically with the department. HMS can assist you in the proper and timely completion of the supplemental schedules and responding to any inquiries by the department in auditing your submitted data.
In addition, we can assist you in the evaluation of the published AB1629 rate for your facility covering a specific fiscal period.
AB915 – “MEDI-CAL OUTPATIENT DSH”
AB915 is a supplemental reimbursement tailored to the needs of an acute care facility providing outpatient services to Medi-Cal beneficiaries and the facility is owned or operated by a county, city, University of California or health care district. The supplemental reimbursement is limited to 50% of the unreimbursed outpatient Medi-Cal cost as determined by the formula used in the request for reimbursement. HMS can assist facilities in preparing a request for reimbursement to the AB915 program.
SECURE DATA TRANSFER (Clients Only)
HMS has subscribed to “ShareFile” by Citrix, a more secure method of transferring sensitive information, such as Protected Health Information (PHI). To utilize this service, our clients submit a request to their HMS representative. Please do not email PHI information to HMS or anyone else unless it is in an encrypted manner.