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DSH – Schedules A, B, C and Updates. Roger Barnes DMA Hospital Reimbursement November 9, 2006. SCHEDULE A. SCHEDULE A. SCHEDULE B. SCHEDULE B. SCHEDULE B. Continued. SCHEDULE C. SCHEDULE C. Unreimbursed Uninsured Patient Charges.
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DSH – Schedules A, B, C and Updates Roger Barnes DMA Hospital Reimbursement November 9, 2006
Unreimbursed Uninsured Patient Charges Unreimbursed Uninsured Patient Charges are limited to inpatient and outpatient accounts or portions thereof for medically necessary services which were unpaid in whole or in part. Relevant statute: 42 U.S.C. 139r-4(g)(1)(A) & SSA 1923 (g)(1)(A)
Unreimbursed Uninsured Patient Charges • The patient had no medical insurance coverage; • The patient had no medical insurance coverage that was in effect at the time the services were rendered;
Unreimbursed Uninsured Patient Charges • The patient had medical insurance coverage in effect at the time the services were rendered, but the coverage did not extend to the services that were rendered; or • The patient had medical insurance coverage in effect at the time the services were rendered, but coverage was denied for services that would have been covered by Medicaid
Unreimbursed Uninsured Patient Charges • You can include U/U charges without regard to whether or not the hospital received state or local government support payments for indigent or low income patients • Payments received for indigent or low income patients by state and local governments can be disregarded in calculating Net U/U charges. • This is for Schedule A only!
EXCLUDEDUnreimbursed Uninsured Patient Charges • Contractual adjustments required by law or contract with respect to services provided to patients covered by Medicare, Medicaid, or other government or private third party payors; or • Services to patients where coverage has been denied by the patient’s public or private payor on the basis of lack of medical necessity unless the services would have met Medicaid medical necessity and coverage criteria.
Update of DSH Plan • State Plan approved effective October 1, 2006 without sunset dates. • Rate adjustment payments (Basic DSH) began in November 2006. • First quarterly DSH payment has a target date of late January 2007.
Update of DSH Plan • CMS has yet to define a pubic hospital. • CMS has not issued further definition of Unreimbursed Uninsured. • Final CMS audit regulations of DSH programs have not been issued.