2013 HAR Education and Information Session Tracy Johnson, MDH Jonathan Peters, MHA Lucas Hovila, MHA

2013 Education and Information Topics Changes to the 2013 Formset & Extension Requests Data Requests & Usage Capital Expenditure Hospital and System Level Reporting Provision for Bad Debts Clinic Reporting on the HAR Reminders, Resources, and Tips Medical Care Surcharge Estimator

2013 Formset Changes The one change to the 2013 HAR Formset is that Provision for Bad Debts is now being reported as a Contractual Adjustment and no longer as an Operating Expense. We will discuss this change later in the presentation.

Extension Requests Increasingly, the legislature and the public are looking for more up-to-date information from government. MDH wants to work with MHA and hospitals on reducing the need for data filing extensions beyond the initial 21 days. We hope MDH will need to grant longer extension requests only in the most extreme cases, where sticking to the timeline would pose and undue hardship on hospitals or compromise the quality of the report.

Extension Policy For the 2013 HAR, MHA is able to grant an initial extension of 21 days. If a hospital is 30 days late submitting their HAR, the hospital will be turned over to MDH.

Extension Requests In FY 2012, 42% of hospitals asked for an extension. Of the 42% of hospitals that asked for an extension, 20% of hospitals asked for an extension of 30 days or greater.

Who Requests HAR Data? Other Areas of MDH MN Legislature MN Department of Human Services Media MN Nurses Association Researchers in Public Policy

What HAR Data is Requested? Uncompensated Care Community Benefit Capital Expenditures Staffing Payer Mix Financial Performance of the Industry Trends in Utilization Bed Type Information

How is HAR Data Used? Community Benefit Report to the Legislature Capital Expenditure Reporting Minnesota Health Care Markets Chartbook (section 8)

Inpatient Bed Capacity at Minnesota Community Hospitals by Region & Specialty Bed Units (2012) Medical/ Surgical Cardiac Chemical Dependency Mental Health (Psychiatric) NeurologyObstetricsOrthopedicRehabilitation Other Specialty Total Available Beds Central ,189 Metro2, ,883 Northeast ,165 Northwest South Central Southeast1, ,622 Southwest West Central Total7, , ,721 Source: MDH analysis of hospital annual reports

Minnesota Hospital Community Benefits by Type, 2011 to 2012 Source: Source: Community Benefit Provided by Minnesota’s Hospitals in 2011, Health Economics Program, Minnesota Dept. of Health, forthcoming

Use of Capital Expenditure Information Capital expenditure information is used by MDH to fulfill statutory requirements to review major spending commitments by hospitals and other providers. MDH also uses capital expenditure data to produce informational documents to inform the public on spending trends.

Analysis of Capital Expenditure Information

Trends at Minnesota Community Hospitals, 2009 to 2012 Percent Change from Previous Year *Actual Value Source: MDH analysis of hospital annual reports

Capital Expenditures A Guide to Minnesota Capital Expenditure Reporting

Contact Information A Capital Expenditure Contact is required by all hospitals. This should list the individual responsible for any questions relating to Capital Expenditures. The Capital Expenditure Contact is required, and is not optional.

Reporting Requirements There are two separate reporting requirements for Capital Expenditures  Reporting of major capital expenditure commitments greater than one million dollars (see HAR sections 56 & 57).  Providing sufficient project specific information about capital expenditure commitments for MDH to complete a retrospective review of each project greater than one million dollars (see capital expenditure project specific tab of the formset).

Reporting Forms Providers submit capital expenditures on existing annual financial reports  Hospitals - Hospital Annual Report (HAR)  Surgical Centers – Freestanding Outpatient Surgical Center (FOSC) Report  Imaging Centers - Diagnostic Imaging Facility Report  Physician Clinics or Clinic Systems – System Capital Expenditure Report  Health Care Systems - Capital Expenditure Report

Health Care Systems Decision Chart

Contact Information: Tracy Johnson HCCIS Staff Minnesota Department of Health

Clinic Reporting Reporting Guidelines for Clinic Information on the Hospital Annual Report

Clinic Decision Flowchart

Offsite Locations Tab All outpatient departments, clinics, and components not located on the hospital's premise Offsite locations where services provided are billed under the hospital's Medicare and Medicaid provider numbers Verified against hospital license application

Offsite Locations Tab Reminder: –This tab is matched against Gross Clinic Charges (account 0207) and Other Institution Charges (account 0208). –If there is an offsite entity being listed in account 0207 and/or 0208, please list these entities on the Offsite Locations Tab. –For each entity that is listed on the Offsite Locations Tab, please fill out all data fields.

Provision for Bad Debts Reporting Guidelines for Provision for Bad Debts

New Way to Report Provision for Bad Debts In previous years, the HAR Formset has asked for Provision for Bad Debts to be included in Total Operating Expense. Due to a change in Financial Accounting Standards Board (FASB) rules, Provision for Bad Debts is now included in Total Adjustments and Uncollectibles.

New Way to Report Provision for Bad Debts Please note that since Provision for Bad Debts is now reported as an adjustment it will be reported as a negative number.

Institution Reporting for Provision for Bad Debts For the Institution Section, Provision for Bad Debts will be reported in account 0216 and included in Total Adjustments and Uncollectibles (account 0220).

Hospital Only Reporting for Provision for Bad Debts Provision for Bad Debts for the Hospital only will be reported in account 0739 and included in Total Adjustments and Uncollectibles (account 8063).

Change to Section 14: Primary Payer Adjustments & Uncollectibles Provision for Bad Debts along with breakout accounts for Hospital Patient Care Services and Other Patient Care Services is now automatically reported on page 7 of the HAR in Section 14. These are auto-calculated cells.

Reminder If your hospital chooses to provide internal numbers and not use the formulas in Sections 23-26, please be sure to include Provision for Bad Debts in the Adjustments on the schedules.

Example For example in Section 23, now that Bad Debt is reported as an adjustment, Physician Bad Debt needs to be included in Physician Adjustments (account 5503).

Reminders, Tips, and Resources for Preparers General Guidelines and Places for Further Information

Medical Care Surcharge Estimator A Medical Care Surcharge Estimation Tool has been included on a separate tab in the HAR After completing the HAR, please review this tab to verify that the information reported on the HAR for these key accounts is accurate. DHS remains the sole determiner of your surcharge, and this tool is to be used only to give guidance and help in the correct completion of the HAR.

MCR and Audited Financial Statement Submission MHA has the ability to receive the Medicare Cost Report in the ECR file format. ECR format is the preferred format for the MCR. Your hospital’s AFS and MCR should be submitted as soon as they become available.

Data Transmission Method Available HTTPS data transmission available –Transmission encrypted and secure –As easy as web or online banking –Hospitals can download their prior year’s Commentary or Hospital Profile report from same site as well. –More safe and secure than postal mail or –No file size restrictions, unlike This method is highly recommended by MDH and MHA for data transmission Please contact MHA to receive your login and password Web address:

Places for Further Information Both MDH and MHA’s website have further information on HAR related issues. –MDH Website: –MHA Website: systems-hccishttp:// systems-hccis All Deadlines and Events are posted on websites. Power Point presentation of 2012, 2011 and 2010 HAR Education and Information Sessions available at sites above. Electronic Newsletters covering the following topics: –Getting Started –Microsoft Excel Tips and Useful Tools –Expense Allocation Methodology –Primary Payer Charges and Adjustments –Outpatient Charges If a question or problem arises while completing the Hospital Annual Report, please contact Jonathan Peters or Lucas Hovila at MHA or Tracy Johnson at MDH (see last slide for contact information).

Contact Information MHA staff at (800) or (651) Jonathan Peters, MHA (651) Lucas Hovila, MHA (651) Tracy Johnson, MDH (651)