YES - Your Medicare Cost Report Still Matters

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YES - Your Medicare Cost Report Still Matters

• Strategic Reimbursement, Inc.
• August 1, 2005

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Even the Government Admits that Medicare is
Overly Complex

• There can be no doubt but that the statutes and
  provisions in question, involving the financing
  of Medicare and Medicaid, are among the most
  completely impenetrable texts within the human
  experience. Indeed, one approaches them at the
  level of specificity herein demanded with dread,
  for not only are they dense reading of the most
  torturous kind, but Congress also revisits the
  area frequently, generously cutting and pruning
  and making any solid grasp of the matters
  addressed merely a passing phase. 
• Chief Justice Ervin, U.S. 4th Circuit Court
  (1994) Rehabilitation Association of
  Virginia v. Kozlowski

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Why Does the Government Still Require Hospitals
to Submit Cost Reports?

• Medicare Profitability used extensively by
  Congress to determine PPS Inflation Updates
• Compliance
• Determine Medicare Outlier payment factors
• Determine reimbursement from various programs
• Determine wage index rates
• The main source of statistical and financial data
  on the hospital industry used by CMS
• Reimbursement for Critical Access Hospitals

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Do Outside Groups Utilize the Cost Report?

• Did you know
• Hospital quality lists such the Solucient Top
  100 Hospitals rely extensively on the Medicare
  Cost Report

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Hospital Cost Report Preparation Objectives

• To insure the Cost Report and supporting
  documentation have been prepared in compliance
  with Medicare regulations
• To insure the Cost Report correctly identifies
  the full and proper reimbursement due to the
  hospital
• To insure the Cost Report properly identifies the
  related hospital costs

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Certification Your Name on the Line

• When you sign your name to the Medicare Cost
  Report, you are certifying that you know
• What is in the Cost Report,
• What is in your books and records, 
• The applicable Medicare laws, regulations and
  instructions,
• That all services provided to Medicare patients
  were in accordance with the law, and
• That everything in the Cost Report is in
  accordance with the law, except as noted.

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Compliance Expectations

• Misrepresentations or falsifications of any
  information contained in this Cost Report may be
  punishable by criminal, civil and administrative
  action, fine and/or imprisonment under Federal
  law. - Cover page of every Cost Report
• Are you confident enough in your Cost Report
  preparation efforts to risk perjury, fines and
  potentially jail?

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Consequences for Lack of Compliance

• If a hospitals compliance is questioned, there
  are potentially large, negative consequences
• Negative publicity for the institution, Board of
  Directors and hospital executives (CEO, CFO)
• Audit issues and related costs of defense
• Settlement costs
• Corporate Integrity Agreement costs

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Cost Reports Reimbursement Impact
Even with the introduction of PPS, the Cost
Report still impacts reimbursement in the
following areas

• Wage Index
• Outlier Payments
• Disproportionate Share
• Direct Medical Education
• Indirect Medical Education

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Reimbursement Impact (cont.)

• Renal Dialysis PPS Add on
• Medicare Bad Debts
• Allied Health Programs
• Psychiatric Unit Transition
• Organ Acquisition

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Reimbursement Impact (cont.)

• Medicaid Cost and/or Rates
• Medicaid DSH Pools
• Rural Health Clinics

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Conclusion The Cost Report Still Requires
Extensive Effort and Attention

• With so much still riding on your Cost Report,
  you cannot afford to turn to anyone but the best.
• Strategic Reimbursement was founded in 1975 with
  the purpose of helping hospitals prepare their
  Medicare Cost Reports. Today, our Medicare
  advisory practice still comprises the backbone of
  our firm.

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SRI History

• Founded in 1975
• Offices Chicago, Milwaukee, Nashville, St.
  Louis, Denver, Phoenix
• Staff of 24
• Service approximately 250 healthcare providers,
  many having been clients for over 20 years

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Financial and 3RD Party Services

• Medicare, Medicaid Cost Report preparation and/or
  review
• Prior year Medicare Cost Report reviews
  Medicare Compliance / Recoupment Program (MCRP)
• Disproportionate Share Hospital (DSH)
  Analysis/Verification
• Contractual management and reimbursement
  professional outsourcing Interim Director of
  Reimbursement (IDOR)
• Wage Index reviews for individual hospitals
  and/or full CBSAs
• Medicare Bad Debt reviews
• PRRB Appeal Services
• Group appeals SSI ratio, out-patient Part B
  blending

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Clinical Services

• Procedure coding reviews
• Medical records chart audits
• CDM review
• Physician and staff compliance education

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Contact Strategic Reimbursement

• For more information on how Strategic
  Reimbursement can help your hospital maximize its
  third party programs, please contact
• Robert Gienko
• President
• 847-259-7373 ext 106
• rgienko_at_srinc.org