Understanding the Data

Faith Asper, MHS

Director, ResDAC Assistance Desk

Objectives

Understand how the processing impacts the data

Recognize key issues

Understand options to deal with issues

2

Annual Filing Requirements

Annual filing of 12 months or 13 four-week periods

May submit partial year reports or partial cost report, under certain circumstances

˗ Change in provider’s fiscal year

˗ Change in provider ownership status

˗ Low or no Medicare utilization

˗ Initiate or terminate with the Medicare program

» Includes change from acute hospital to Long Term Care Hospital or Critical Access Hospital

Implication is that multiple cost reports per provider per year exist.

3

Providers with Multiple Cost Reports by Year

FFY 2007 FFY 2008 FFY 2009 FFY 2010 FFY 2011 FFY 2012

> 1 Cost Rpt 91 102 95 47 41 0

1 Cost Rpt 5995 5991 6005 6040 5903 846

97%

98%

98%

99%

99%

100%

100%

Pe

rce

nt

4

Providers with Multiple Cost Reports

81%

14%

5%

Federal Fiscal Year 2011

Fiscal Year Change

Ownership Change

Initial/Last Cost Report

Reasons for Multiple Cost Reports

5

Multiple Cost Reports

Fiscal year changes: ˗ Use all cost reports provided to come up with an overall

average

˗ Use the cost report that represents the majority of the fiscal year

Ownership change: ˗ Need to keep the cost reports separate because the change

in ownership could change how information is reported in the cost reports

Low or no Medicare utilization ˗ No information will be available for these facilities

Initiate or terminate with Medicare ˗ Use the information that is available

Options for handling multiple cost reports

6

Quarterly Updates to Data Files

CMS overwrites the cost report data in HCRIS each

quarter with the highest status cost report.

Changes in status codes indicate changes to the data

files.

It is not easy to identify the changes with each

download.

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Cost Report Status Codes

The order of the status codes is (lowest to highest):

˗ As Submitted

˗ Settled without Audit

˗ Settled with Audit

˗ Reopened

˗ Amended

8

Status Codes by Fiscal Year

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Amended

Reopened

Settled with Audit

Settled without Audit

As Submitted

Fiscal Years 2007-2011, March 2013 download

9

Changes to the Data Files

Depending on your study, researchers may need to

˗ Download a point in time cost report data set and work

with that set for the project

˗ Download the cost report data each quarter in order to

have the most up to date information

Options for handing changes to the data files

10

Reopened Cost Reports

Cost reports can be “Reopened”, which means that it

was opened again by the provider, the Medicare

Administrative Contractor (MAC), or CMS

Cost report can be reopened for up to 3 years starting

from the settlement date otherwise known as Notice

of Program Reimbursement (NPR).

If not reopened within 3 years, the cost report

becomes final.

Only exception to this rule is in the case of fraud.

11

FY 1996 Cost Reports Status Changes

12

0

500

1,000

1,500

2,000

2,500

3,000

2002 Update 2006 Update 2010 Update 2013 Update

As Submitted Settled Settled w/Audit Reopened

Reopened Cost Reports

Same situation as constantly changing download

Depending on your study, researchers may need to

˗ Download a point in time cost report data set and work

with that set for the project

˗ Download the cost report data each quarter in order to

have the most up to date information

Options for handing reopened cost reports

13

Time Lag

Cost Report due to Fiscal Intermediary (FI) 5

months after the close of the provider’s Fiscal

Year.

Usually takes about 12-18 months for the latest

FFY to be complete.

See flow chart at the end of this segment.

FFY 2012 Hospital Cost Reports Completion

14

Update Percent Complete

March 2013

(6-months past FFY end)

14%

June 2013

(9-months past FFY end)

53%

Cost Reports Time Lags

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

FFY 2007 FFY 2008 FFY 2009 FFY 2010 FFY 2011 FFY 2012

FY End Dt & MAC Receipt Dt FY End Dt & Dt in HCRIS

Median Number of Months

15

Time Lags

Be aware that it may take some time for the cost

reports to appear in the download

This may influence the years you include in your

analysis

Options for handing time lag

16

Free-Standing Facilities vs Provider Based

Cost report download includes free-standing facility and any provider-based facility

The forms used to collect the information differ between free-standing facilities and provider-based facilities.

17

Free-Standing Facilities vs Provider Based Some provider cost reports are located in multiple

databases

˗ SNF (found in 2 downloads)

» Free-standing SNF and Hospital download

˗ RHC (found in 4 downloads)

» Free-standing RHC, Hospital, SNF, HHAs

˗ HHA (found in 3 downloads)

» Free-standing HHA, Hospital, SNF

˗ Hospice (found in 4 downloads)

» Free-standing Hospice, Hospital, SNF, HHA

˗ Renal (found in 2 downloads)

» Free-standing Renal facilities, Hospital

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Determining Reliability of Data

Consult the instructions for completing the worksheet

(PRM 15-2)

˗ Is the Worksheet or variable required?

» Within the PRM 15-2 (“pr2_40” for Hospitals)

˗ Is the Worksheet or variable audited?

» Within the Electronic Reporting Specifications

(“R3P240S”), Table 6: Edits, Level I & II

˗ What electronic edit checks are in place for this

variable?

» Within the Electronic Reporting Specifications

(“R3P240S”), Table 6: Edits, Level I & II

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Determining Reliability of Data

Determine if the variable is used in the settlement

summary

˗ Worksheet E

Check the number of missing or extreme values in the

data

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Why Use the Cost Report Data?

Only national data available for all types of

providers

˗ Non-profit

˗ For-profit

˗ Government

But remember…

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