2. Summary of Changes to the Hospital Cost Report 1

3. Introduction to T19 This presentation will review Transmittal 19 and the various changes to the hospital cost report. This presentation includes information regarding the time for implementation of the changes and a discussion of how the changes affect specific parts of the cost report and related issues. The presentation will address the following topics in the order depicted below. Implementation and ScopeCost Report Form ChangesForms - ExamplesEdits 2 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

4. Our new 32-bit software uses a yellow cube icon as a shortcut to start the program. Only our 32-bit software incorporates all the T19 changes. HFS 16-bit software is started by double clicking on a red cube icon. The 16-bit software does not include T19 changes and cannot be used to prepare and submit hospital cost reports. Only the 32-bit software is approved by CMS. Desktop icon for 32-bit software is yellow. Thus T19 requires yellow icon software. T19 Requires our 32-bit software… 3 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

5. primeval cube (1980’s) colorized cube (1990’s) Red Icon (1990 - ?) Yellow Icon (2008) Timeline of the Cube 4 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

6. Scope & Implementation 5 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

7. FORMS

8. Worksheet L The primary change in T.19 is the phase out of Capital IME (Worksheet L part I, line 4.03). For services on or after 10/1/2008 to 9/30/2009, only 50% of the Capital IME is allowed. For services 10/1/2009 and after, no Capital IME is allowed (i.e. line 4.03 is zeroed). For 10/1 to 9/30 FY, we compute the 50% adjustment for 10/1/2008 to 9/30/2009; or zero for after 10/1/2009. We will subscript W/S L part I column 1.01, lines 2, 4.02, and 4.03 based upon the FY dates on S-2 line 17. 7 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

9. Worksheet L - Capital DRG (other than outlier) 8 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

10. Worksheet L with subscripted column 1.01 9 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

11. Worksheet L – Stimulus Bill Superceded T19 10

12. Manufacturer Credits If credit or warranty ≥ 50% of replacement cost of device, provider is to show on the bill for the new device, the Condition Code 49 (replacement) or 50 (recall), and a value code of FD. new line 24.98 for “Credit for MFR Replaced Med Devices”. This is similar to line 24.99, which can only be used by FI/MACs, for the Outlier Reconciliation. PS&R The PS&R 110 Report is to capture this amount, and it will then go to E part A, line 24.98. If billed correctly, should map the PS&R amount to line 24.98. This is always a subtraction (reduction of cost). ESRD E part A, lines 5-5.03 added “MS-DRG” reference. MS-DRG = Medicare Severity Diagnosis Related Group. Lines 5 to 5.03 (ESRD) were clarified for discharges on or after 10/1/2007, to include “MS-DRG” numbers 652, 682, 683, 684, and 685, as well as the previously listed 302, 316, and 317. Worksheet E, part A 11 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

13. Worksheet E, part A 12 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

14. Worksheet E-3 part VI W/S E-3 part VI, lines 2 and 13 were clarified to NOT allow negative FTE. Since these lines are input, we will force them to zero, if they are negative. 13 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

15. Worksheet S-2 Line 21.03, col. 5 Enter the hospital's CBSA code in line 21.03 col. 5 Lines 24 & 24.01 S-2 lines 24 and 24.01 expanded the OPO (organ Procurement Organization) and the Medicare Transplant Center, including a new column 3 for the Termination Date or Recertification Date. Lines61 & 62 Lines 61 & 62, enter “Y” in line 61, if you are a multi-campus facility, with campuses in different CBSA locations. Complete line 62 if line 61 = “Y.” Line 63 Line 63 is to indicate, Y/N, if the PS&R was used to complete the cost report. If “Y”, enter the claims “Paid Through Date” in column 2. 14 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

16. Worksheet S-2, line 21.03 15 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

17. Worksheet S-2, lines 24 & 24.01 16 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

18. Worksheet S-2, lines 61 - 63 Bug Alert!!! Wrong line number. 17 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

19. LEVEL I EDITS

20. 1002L Level I edit 1002L is new, to check line 5.04 on L part I, is zero if S-2 line 21.03 column 1 = 1 (Urban), and bed size is less than 100; or S-2 line 21.03 column 1 is “2” for Rural. 1041S S-2, lines 25, 25.01 & 25.02 Must agree with E-3 part IV line 23.01 1046S S-2 lines 37 & 37.01 are “N” Hold Harmless expired 10/1/2001 (+8) 1085A S-2 lines 42-43 in sync with A-8-4 Only CAH use A-8-4 Level I Edits 19 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

21. 1026D Compares S-3 part I, line 3, column 4 and D-1, sum of lines 10 and 11. D-1 line 10 days subtracted from S-3, equals D-1, line 11. 1041E 1071E Modified for Psych and Rehab, to NOT apply if there is no Medicare Utilization (no I/P days on S-3). 1085E Make sure dual eligible bad debts don’t exceed total bad debts. It doesn’t apply if total bad debts are negative (excess recoveries). 1009I Level I edit 1009I was clarified to check I-3 line 16, column 3 is greater than zero, to define “worksheet is present”. Level I Edits 20 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon

22. LEVEL II EDITS

23. 2027 Level II Edit 2027 was codified in T.19 (added as a T.18 Flash). This issues if Worksheet C ratios are greater than 1.000000 or less than 0.001000. Many reports will fail this edit. Level II needs to be explained (if asked), and the provider should explain why cost is high and charges low, or vice versa (i.e. PS&R assignments wrong? AAI assignments wrong?). Level II Edits 22 Health Financial Systems 2552-96 Transmittal 19 by Pete Harmon