1 / 10

Welcome to the Jurisdiction 11 (J11) Part A World!

Welcome to the Jurisdiction 11 (J11) Part A World!. Audit and Reimbursement (AR). NGS AR Activities: Wage Index Desk Review-Audits Settlements Lead of the Process Reopening Primary Reviewer. Palmetto GBA AR Activities: Reimbursement Cost Report Receipt Settlements

kiet
Download Presentation

Welcome to the Jurisdiction 11 (J11) Part A World!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Welcome to the Jurisdiction 11 (J11) Part A World!

  2. Audit and Reimbursement (AR) • NGS AR Activities: • Wage Index • Desk Review-Audits • Settlements • Lead of the Process • Reopening • Primary Reviewer • Palmetto GBA AR Activities: • Reimbursement • Cost Report Receipt • Settlements • Issue the Settlement • Reopening • Filed Directly to Palmetto GBA • Cost Report Appeals • Payments

  3. Occupational Mix Survey • FY 2010-2012 wage index based on 2007-2008 Survey • FY 2013-wage based on 2010 survey • CY 2010 Occupational Mix Survey • Published in the January 15, 2010 Federal Register • Due to MAC no later than July 1, 2011

  4. Wage Index – Pension Expense • CMS instructions dated November 9, 2011 • Guidance for determining defined pension Plan cost for FY 2013 wage index • Different treatment for wage index and cost finding

  5. Pension Expense • ERISA rules changed, not standard actuarial basis or limit for pension costs • Previous Medicare treatment: Allow pension contributions • must be paid within one year to liquidate liability • New Medicare treatment: Allow cash contributions

  6. Wage Index – Pension Expense • Effective beginning FY 2013 wage index calculation • Use actual pension contributions funded during the reporting period on a cash basis • Trending • Use average of cash contributions for three years • Transition policy for “prefunded” pension plans • 10 year transition for cash contributions made in excess of wage index amounts for periods beginning on or after 10/01/2002 and prior to 10/01/2008

  7. FY 2012 IPPS Final Rule • Effective for cost report periods beginning on or after October 1, 2011 • Actual contributions to pension plan allowed on cash basis • No longer a one year period to liquate the liability • 150 percent limit on contributions • 150 % of three consecutive Medicare cost report periods out of five most recent cost report periods with the highest average • If contributions are in excess of limit, hospital must demonstrate costs are reasonable and necessary

  8. Electronic Format • Transition to paperless environment • More efficient for providers and MAC • Electronic workpapers • More secure • Encryption required for (PHI, PII) • Correspondence and NPRs sent through email • Need to ensure A & R email contacts are current

  9. Miscellaneous • DSH Eligibility • Medicaid eligibility must be confirmed by the state agency • Status of NPRs on hold • PS&R • SSI data

  10. Questions ?

More Related