1. September 14, 2015 1 Welcome to the Jurisdiction 11 (J11) Part A World!

2. September 14, 2015 Audit and Reimbursement (AR)  NGS AR Activities: Wage Index Desk Review-Audits Settlements  Lead of the Process Reopening  Primary Reviewer  Palmetto GBA AR Activities: Reimbursement Cost Report Receipt Settlements  Issue the Settlement Reopening  Filed Directly to Palmetto GBA Cost Report Appeals Payments 2

3. September 14, 2015 Occupational Mix Survey FY 2010-2012 wage index based on 2007-2008 Survey FY 2013-wage based on 2010 survey CY 2010 Occupational Mix Survey Published in the January 15, 2010 Federal Register Due to MAC no later than July 1, 2011 3

4. September 14, 2015 Wage Index – Pension Expense  CMS instructions dated November 9, 2011 Guidance for determining defined pension Plan cost for FY 2013 wage index Different treatment for wage index and cost finding 4

5. September 14, 2015 Pension Expense  ERISA rules changed, not standard actuarial basis or limit for pension costs  Previous Medicare treatment: Allow pension contributions must be paid within one year to liquidate liability  New Medicare treatment: Allow cash contributions 5

6. September 14, 2015 Wage Index – Pension Expense  Effective beginning FY 2013 wage index calculation  Use actual pension contributions funded during the reporting period on a cash basis  Trending Use average of cash contributions for three years  Transition policy for “prefunded” pension plans 10 year transition for cash contributions made in excess of wage index amounts for periods beginning on or after 10/01/2002 and prior to 10/01/2008 6

7. September 14, 2015 FY 2012 IPPS Final Rule  Effective for cost report periods beginning on or after October 1, 2011  Actual contributions to pension plan allowed on cash basis  No longer a one year period to liquate the liability  150 percent limit on contributions 150 % of three consecutive Medicare cost report periods out of five most recent cost report periods with the highest average If contributions are in excess of limit, hospital must demonstrate costs are reasonable and necessary 7

8. September 14, 2015 Electronic Format  Transition to paperless environment More efficient for providers and MAC Electronic workpapers More secure Encryption required for (PHI, PII)  Correspondence and NPRs sent through email Need to ensure A & R email contacts are current 8

9. September 14, 2015 Miscellaneous  DSH Eligibility Medicaid eligibility must be confirmed by the state agency  Status of NPRs on hold PS&R SSI data 9

10. September 14, 2015 Questions ? 10