Georgia MedicaidDSH Audit TrainingOctober 29th, 2009

Jim Erickson, Member

Myers and Stauffer LC

2

Training Overview

Update on 2005 & 2006 DSH Audits

Review of DSH Data Requirements for DSH Audit and Payment Processes

Review of the Medicaid DSH Survey Tool

Questions and Answer Session

Update on 2005 & 2006 DSH Audits

Submitted Surveys are Currently being reviewed

Select hospitals will be contacted for additional verification through field audits Likely scheduled for January Will involve1-2 days of field work depending on

hospital size

3

Update on 2005 & 2006 DSH Audits Additional Guidance from CMS

Reports will not be considered out of compliance if delivered to states by 9/30/10 and to CMS by 12/31/10

States must still be making an effort to complete and provide updates to CMS

Data Reports and Audits should be based on the best

available information Goal is for states to accurately report on these elements

by the end of the transition period (SFY 2011)

4

5

Questions/Comments?

DSH Data Requirements Audit & Payment Audit requirements created specific definitions

for uncompensated care costs Definition of uninsured Costing Methodology

Differed from previous payment definitions and cost methodology

Use a single survey document to collect data for both uses

Get back to an annual survey that will satisfy both purposes

6

DSH Data Requirements Audit & Payment 2005 & 2006 DSH Audit (Surveys Done)

Collected data from cost reports that cover: 7/1/04 – 6/30/05 (SFY ‘05) 7/1/05 – 6/30/06 (SFY ‘06)

2007 DSH Audit Collect data from cost reports that cover:

7/1/06 – 6/30/07 (SFY ‘07)

2010 Payment Cost reports ending in 2008

7

DSH Data Requirements Audit & Payment Example Provider with 12/31 Fiscal Year:

8

1/1/04 – 12/31/04 1/1/05 – 12/31/05 1/1/06 – 12/31/06 1/1/07- 12/31/07 1/1/08 – 12/31/08

Cost Report Periods

SFY ‘05 DSH Audit

SFY ‘06 DSH Audit

SFY ‘07 DSH Audit

2010 DSH Payment

SFY ‘08 DSH Audit

Done Done DoneNeed to Make

2010 DSH Payments

9

Questions/Comments?

10

Medicaid DSH Surveys (2007 Audit / 2010 Payment)General Instruction and Identification of Cost Report Years

Select your hospital from the drop-down menu Verify provider number is correct DSH year begin and end dates will populate Identify the cost report years needed to completely cover DSH year

Example: DSH year 7/1/06 thru 06-30-07Cost report years needed: 1-1-06 thru 12-31-06*, and

1-1-07 thru 12-31-07

* - If the hospital received a SFY ‘06 DSH payment and completed the 2006 DSH audit survey this would already be reported so 12/31/07 would be the only cost report to report on.

11

Medicaid DSH Surveys (2007 Audit / 2010 Payment)General Instruction and Identification of Cost Report Years

Answer survey questions (4-6 on ‘07 Audit Survey, 6-8 on ‘10 Payment Survey) to determine if hospital is eligible to receive DSH payments

Supporting documentation for all DSH survey responses must be maintained by your hospital (for a minimum of 5 years)

12

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section A – Cash Subsidies and Charity Care Charges

The state must report your actual MIUR and LIUR for the DSH year - data is needed to calculate the LIUR

Provide the amounts for each cost report year needed to cover the DSH year

If cash subsidies are specified for I/P or O/P services, record them as such, otherwise record entire amount as unspecified

13

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section B – Out of State Medicaid Provider Numbers

List your Medicaid provider names and numbers for states other than Georgia

If more lines are needed than provided on the form, attach a complete list to your survey

14

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section C – Net hospital revenue from patient services

Information is needed to determine your actual LIUR for the DSH year. A separate schedule must be used for each cost report year covering a portion of the DSH year.

Data elements used in calculation are: Inpatient hospital charges Net hospital revenue

Note: The form provides space to allocate contractual allowances among service centers. If such an allocation is not reasonable, record a single amount for hospital services and a single amount for non-hospital (i.e., hospital-based skilled nursing facility, home health agency, etc.) services

15

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section D – Calculation of Medicaid and Uninsured Costs (Using Cost Report

Methods)

For each cost report covering a portion of the DSH year, the hospital should record the routine per diem costs and ancillary cost-to-charge ratios for each cost center. Use cost report schedules D-1 and C for these values

Enter inpatient (routine) days, I/P and O/P ancillary charges. The form will calculate cost for: In-State FFS Medicaid (from Medicaid (HS&R) In-State Managed Care (from Hospital Records) In-State FFS Cross-Over (from Hospital Records) In-State Managed Care Cross-Over (from Hospital Records)

Payment data should agree to HS&R (or paid claims report from MMIS) reports from Medicaid and/or hospital internal records

16

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section D – Calculation of Medicaid and Uninsured

Costs (Using Cost Report Methods)

For uninsured services, patient days (by routine cost center) and ancillary charges by cost center are needed

Survey form Exhibit A shows the data elements that need to be collected and provided to Myers and Stauffer. This data will allow us to cost your uninsured services using cost report mechanics

Uninsured services need to be identified for each cost reporting period covering a portion of the DSH year.

17

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section D – Calculation of Medicaid and Uninsured Costs (Using Cost Report

Methods)

Payment received for uninsured services need to be reported on a cash basis For example, a cash payment received during the ’07 DSH year (7-1-06 thru 6-30-07) that

relates to a service provided in calendar 2004, must be used to reduce uninsured cost for the ’07 DSH year

Survey form Exhibit B has been designed to assist hospitals collect and report uninsured payments received data

DSH hospitals should make a reasonable effort to identify insurance status when care was provided for all patient payments received during the DSH year. If service dates are so outdated that insurance status cannot be identified, report these cash collections on Exhibit B-1. Payment will be allocated between insured and uninsured using your collection stat during the time period when insurance status could be identified

18

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section D – Calculation of Medicaid and Uninsured

Costs (Using Cost Report Methods)

Uninsured Services: Uninsured patients are individuals with no source of third party health care coverage (insurance). If the patient had health insurance, even if the third party insurer did not pay, those services are insured and cannot be reported as uninsured on the survey

19

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section E – Out of State Medicaid Services

Medicaid days, ancillary charges and payments received must be reported on this section of the survey. The cost and payments for another state’s Medicaid services are included in your hospital’s uncompensated care costs

The data needed should be reported in the same format as data on Section D. Days, charges and payments received must agree to the other state’s HS&R (or similar) claim payment summary

If your hospital provided services to several other states, please consolidate your data and provide detailed support for your survey responses

20

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section F & G – Transplant Hospital Organ Acquisition Costs

These schedules should be used to calculate organ acquisition cost for Medicaid (in-state and out-of-state) and uninsured

Report data for each cost report year needed to cover the DSH year

Summary claims data (HS&R) or similar documents and provider records (organ counts) must be provided to support the charges and usable organ counts reported on the survey

21

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Section H – Section 1011 and Out of State DSH Payments

Section 1011 provides reimbursement for emergency health services furnished to undocumented aliens. Because a portion of the payments are made for cost recognized for DSH, a portion of these payments must be recognized on behalf of uninsured hospital services

You must report your Section 1011 payments included in payment on Exhibit B (posted at the patient level), received but not included in Exhibit B, and separate the 1011 payments between hospital services and non-hospital services (non-hospital services include physician services)

If your facility received DSH payments from another state (non-Georgia DSH payments), these payments must be reported on this section of the survey

Report any Medicaid supplemental payments made based on the state fiscal year.

22

Medicaid DSH Surveys (2007 Audit / 2010 Payment)Certification

Answer the question addressing if your hospital was allowed to retain 100 percent of the DSH payments it received. Providing IGT/CPE funding is not the basis for a no answer

The hospital’s CEO or CFO must certify as to the accuracy and completeness of your survey responses

Provide contact information for person(s) responsible for completing survey

23

Other Information:

Please use the DSH Survey Submission Checklist

Send survey and other data to:Myers and Stauffer LCAttn: Georgia DSH Survey11440 Tomahawk Creek ParkwayLeawood, Kansas 66211

Questions: Phone: (800) 374-6858e-mail: gadsh@mslc.com

24

Questions/Comments?