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Affordable Care Act Section 3133 Medicare DSH. HFMA Education Session # 3 February 21, 2013. Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) payments. Presented by: Paul Bouganim Principal Financial Analyst Cedars-Sinai Medical Center. Agenda.

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affordable care act section 3133 medicare dsh
Affordable Care ActSection 3133 Medicare DSH

HFMA Education Session # 3

February 21, 2013

Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) payments.

Presented by:

Paul Bouganim

Principal Financial Analyst

Cedars-Sinai Medical Center

agenda
Agenda
  • New DSH Formulas and Projections
  • Wkst S-10 and Charity Care
  • CMS National Provider Call, January 8, 2013 – Donna Anglin, 2552PROplus, LLC.
  • Legal Update and Data Sources – John R. Hellow, Hooper Lundy & Bookman, Inc.
dsh payment formula effective fy 2014 discharges on after 10 01 13
DSH Payment Formula Effective FY 2014(Discharges on/after 10/01/13)
  • Base DSH Payment
  • 25% of DSH payment computed under existing law – 42 CFR 412.106
  • Plus
  • Add-on Payment - Product of three factors:
  • Factor 1 = 75% of national aggregate DSH payments under existing law
  • Factor 2 = A measure of the percentage change in the uninsured population age < 65 since 2013 (FY, CY)?
  • Factor 3 = A hospital specific percentage of national aggregate charity care
dsh payment formula effective fy 2014 discharges on after 10 01 131
DSH Payment Formula Effective FY 2014(Discharges on/after 10/01/13)
  • Add-on Payment:
  • Factor 2 = A measure of the percentage change in the uninsured population age < 65 since 2013 (FY, CY)?
    • 1 minus the % change from 2013 to “most recent period” minus 0.1% in 2014 and minus 0.2% in 2015 through 2019
  • Factor 3 = A hospital specific percentage of national aggregate charity care
    • Period not specified by Section 3133; left to Secretary to select period
slide5

Let’s Take a Look…

(-0.2% for FY2015 to FY2019)

charity care and wkst s 10 nothing ties
Charity Care and Wkst S-10 – Nothing Ties!

Financial Statements

IRS Form 990

Worksheet S-10

OSHPD

Medicare

charity care and wkst s 10
Charity Care and Wkst S-10
  • Financial Statements
    • Traditional Charity Care
    • Unpaid cost of Medicaid*
    • Unpaid cost of Medicare
    • Research
    • Other Community Benefits
  • IRS Form 990 (Schedule H)
    • Traditional Charity Care
    • Unpaid cost of Medicaid*
    • Unpaid cost of Medicare
    • Research
    • Other Community Benefits
  • *Including State/Local Government Programs

Consolidated Financials

  • Medical Center Only
  • Excludes GME
  • Different Community Benefits
charity care and wkst s 101
Charity Care and Wkst S-10
  • Medicare (2552-10, Wkst S-10)
    • Traditional Charity Care
    • Unpaid cost of Medicaid*
    • Non-Medicare Bad Debts
  • OSHPD
    • Traditional Charity Care
    • Reported at gross charges
  • *Including State/Local Government Programs

Likely to be the default definition of Charity Care for DSH, maybe…

S-10 Also Used for EHR Incentive Payments!

bonus slide
Bonus Slide:

(b) Medicare Share:

IP Part A Days + IP Part C Days

÷

Total IP Days x [ (Total Charges - Charity Care Charges) ÷ Total Charges ]

charity care and wkst s 102
Charity Care and Wkst S-10

Unpaid Cost of Medicaid

Overall Facility Cost-to-Charge Ratio, Wkst C, Part I

Gross Medi-Cal and Medi-Cal HMO Charges (Provider Records)

charity care and wkst s 103
Charity Care and Wkst S-10

Traditional Charity Care

  • Gross Charges
  • Internal Report of all Accounts with Charity Code Write-Off
  • Separated between Accounts w/ Insurance Pmt and w/o Insurance Pmt
  • Any payments posted to account are offset
  • Charity Write-Off: Formal application and approval for Charity Care

EHR!

charity care and wkst s 104
Charity Care and Wkst S-10

Non-Medicare Bad Debt

  • Non-Medicare Bad Debt
  • End Game:
    • Unpaid Medicaid: $65,178,384
    • Traditional Charity Care: $52,438,879
    • Non-Medicare Bad Debt: $51,105,059
              • $168,722,322

Ln 30 for DSH? Charity + Bad Debt Only