Occupational Mix Survey

Posted on July 25, 2008 by Kendall Quisenberry

Welcome to this new entry into my Reimbursement Blog! We invite you to take a moment and subscribe to the blog through the link at the bottom of this page.

This entry is important because it will inform you of due dates for the Medicare Occupational Mix Survey that will be applied to Hospital’s Medicare Wage Index from FY 2010 to FY 2012. Anything that effects the wage index is vitally important to PPS reimbursed Hospitals. If it effects the wage index for three consecutive years, then….

The 2007-2008 Occupational mix survey will collect hospital specific wages and hours data by type of clinician (RN, LVN, Aide, Etc.). The completed survey must be submitted to FI by September 1, 2008. The survey is available on CMS’ website. To see the survey click here.

The interesting note about the Occupational Mix Survey is that the financial impact of the survey is somewhat counter-intuitive. Most would think that a higher mix of staff would mean added reimbursement. In reality, when a close look at the mechanics of the calculation is done, the lower the skill mix of staff that is reported on the survey the more reimbursement a hospital will receive. This may be as good a time as any to recheck those clinicians credentials to make sure your “RN’s” and “LVN’s” have competed all the requirements to keep their credentials (i.e. continuing education, etc.). It would also be a good idea to get Nursing Administration’s input into the contents of the survey. They may be privy to recent developments with regard to a clinicians status that have not found their way to personnel or the applicable information systems.

The preliminary, unaudited 2007-2008 Occupational Mix Survey data should be released by CMS in early October 2008.

I hope this and all future blog entries help you identify the most important of reimbursement issues and new developments in the field for you.

Sincerely,

Kendall Quisenberry
President
Reimbursement Counselors
(972) 403-9910

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Wage Index Issues

Posted on July 15, 2008 by Kendall Quisenberry

Hello, my name is Kendall Quisenberry and I am the President of Reimbursement Counselors. Welcome to the second entry into my Reimbursement Blog!

Periodically, I hope to provide you with key insights, tips, and little nuggets of information you can use to help your facility achieve its goals. We invite you to take a moment and subscribe to the blog through the link at the bottom of this page.

This entry is important because it will inform you of important dates for the FFY 2009 wage index and other recent wage index related developments.

CMS Posts FFY 2009 Wage Index Development Time Table

On October 9, 2007, CMS posted the FFY 2009 Wage Index Development Time Table on their website. The preliminary wage data files were released on October 5, 2007. The most important date on the Time Table from a hospital manager’s prospective is December 7, 2007. This is the deadline for hospitals to submit requests for a revision to their Worksheet S-3 wage data. The request for revision must be accompanied by documentation to support each requested revision. FI’s will be allowed until February 13, 2008 to complete all desk reviews for wage data and transmit the revised data to CMS.

If your facility has not begun the process of reviewing its wage index data or engaged an outside consultant to do so, now is the time to act. This is particularly important for hospitals that make up a significant portion of their CBSA and are reimbursed based upon a prospective rate, but the effect of the wage index should not be underestimated by any hospital adminstrator. Small adjustments to the wage data can produce large swings in the amount of Medicare reimbursement ultimately received.

CMS Includes Additional Contract Labor in Wage Index

The FFY 2008 Final Rule was published on August 22, 2007. The Final Rule stated that contract labor for Administrative & General, Dietary, Housekeeping and management contracts would be included in the FFY 2008 wage index. Since this data has been included in the FFY 2008 wage index, hospital administrator’s should ensure Worksheet S-3, Part II, Line 9.03, 22.01, 26.01 and 27.01 are properly completed for the FFY 2009 wage index.

While the inclusion of Dietary and Housekeeping contract labor may actually decrease a facility’s average hourly rate, the Administrative & General and management contracts have the potential to increase the average hourly rate significantly. In any event, the goal should be to get it right (i.e. compliant) regardless of the impact. For those facilities with current management contracts in place, steps should be taken to ensure the the number of labor hours that are associated with the payments can be identified. If the hours cannot be identified, the hospital should make changes to the contract or billing procedures to ensure that the hours can be identified for future periods. If the hours cannot be identified, the payments will not be able to be included in the wage index. Another proactive step that should be considered by management is to implement an electronic method to accumulate contract labor hours throughout the fiscal year. This can save hours of your staff’s time or reduce the amount of consulting fees paid.

I hope this and all future blog entries help you identify the most important of reimbursement issues and new developments in the field for you.

Sincerely,

Kendall Quisenberry
President
Reimbursement Counselors
(972) 403-9910

 

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Welcome / Medicare Bad Debt Policy Change

Posted on August 20, 2007 by Kendall Quisenberry

Hello, my name is Kendall Quisenberry and I am the President of Reimbursement Counselors.

Welcome to the first official entry into my Reimbursement Blog! Reimbursement Counselors is a consulting firm that offers a full line of services to our healthcare clients. Periodically, I hope to provide you with key insights, tips, and little nuggets of information you can use to help your facility achieve its goals. We invite you to take a moment and subscribe to the blog through the link at the bottom of this page.

Our Mission is to help our clients to better serve the healthcare needs of their communities by providing them with best-in-class advice and service through our team of experienced and innovative consultants

We invite your comments, feedback and questions regarding the issues discussed in the blog. Our first issue is a very important one and is included below.

Medicare Bad Debt Policy Change

TrailBlazer Health Enterprises has institued a new policy with regards to Medicare Bad Debts. The policy requires that Medicare Bad Debts be returned from any collection agencies that are utilized prior to inclusion on the Medicare Cost Report. This means that, if you write-off a Medicare Bad Debt after 120 days and then send to a collection agency, the bad debt can not be claimed at the write off date under the new policy. If you are not having accounts returned from your agencies timely, now is the time to request the agencies return those accounts periodically to you. Please note that Medicare and non-Medicare accounts of like amounts should always be treated the same; therefore, the frequency of the return of the accounts from the collection agency should be consistent across payor classes.

images1.jpgThe knowledge of this new policy change will be particularly important for hospitals with upcoming year ends from 9/30 to 12/31 that currently are not having accounts returned from their agencies. If you want to claim Medicare Bad Debts on your 2007 cost report, you must obtain confirmation of the return of the account by the last day of your fiscal year; otherwise, the accounts will not be allowable until they are returned which may fall in the 2008 fiscal year or later.

This new policy should not effect duel-eligible (Medicare/Medicaid) patient claims where Medicaid has not paid the full amount of the deductible and coinsurance. The duel eligible patients with unpaid deductible and coinsurance amounts should be deemed indigent under your indigent policy upon receipt of the Medicaid RA. These accounts should not be sent to a collection agency. They are eligible to be claimed as a Medicare Bad Debt on the date the patient account is adjusted to reflect the indigency determination.

The new policy is posted on TrailBlazer Health Enterprises web site. To see the post click here. You will also need to click on “I Accept” at the bottom of the page.

We have developed new strategies that may help you recover any reimbursement lost due to the implementation of this new policy. Some of these strategies do have strict filing deadlines (i.e. statutes of limitation), so it is important to act quickly upon action by TrailBlazer Health Enterprises or other Fiscal Intermediaries.

Thanks for taking the time to view this first entry. We sincerely hope this information helps you. Please do not forget to subscribe via the link at the bottom of the page to ensure you get future entries timely.

Sincerely,

Kendall Quisenberry
President
Reimbursement Counselors
(972) 403-9910

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Critical Access Hospital Cost Assignment, Reclassification and Allocation Review

Posted on August 10, 2007 by Kendall Quisenberry

We recently completed a review of CAH’s methods for cost assignment, reclassification and allocation. This review was based upon a 2006 Medicare/Medicaid Cost Report, but was intended to help them improve their reporting for the FYE 2007.

Their 2006 report was prepared to a well respected accounting firm that specializes in small and mid-size facilities. Over the course of our review, we found several material opportunities in each of the areas within the scope of the project. We project an increase in reimbursement of approximately $140,000 for the FYE 2007 Medicare/Medicaid Cost Report .

Our client has also ask us to go back and collect the reimbursement that was lost due to these errors in prior years through the cost report reopening process. Our fee for the initial review, including expenses, was less than $7,500, so the return-on-investment for our client on this project will be outstanding.

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Reimbursement Counselors’ Exciting New Content Rich Website and Blog

Posted on August 10, 2007 by Kendall Quisenberry

In August 2007, Reimbursement Counselors implemented a new website. The new website is not just a static marketing site, but will be content rich site that changes as often as the Medicare policies and regulations.

It will include our recent success stories and Kendall Quisenberry’s new blog. We hope the site will likely became a valued resource for CEO’s, CFO’s, Director’s of Reimbursement and others in the health finance field.

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