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SSI Data to be Released in 60 to 90 Days

From: HFMA Region 11 Conference – 1/30/12

Paul Crofton from the PRRB shared in a session earlier this week at the HFMA Region 11 conference, that CMS would be releasing the long awaited SSI information within the next 60 to 90 days.  The final PPS rules for FFY 2011 modified the match process and the paid claims information included in the SSI match from 6 months after the fiscal year to 15 months of paid claims information after the fiscal year (See 8/16/10 FR Excerpt). Based on the new criteria SSI criteria effective for issuances on or after October 1, 2010, we should be anticipating the following SSI issuances: 

•          FFY 2006 – Reprocessed Listing
•          FFY 2007 – Reprocessed Listing
•          FFY 2008 – New Release (After 3/31/10)
•          FFY 2009 – New Release (After 3/31/11)
•          FFY 2010 – New Release (After 3/31/12)

The delay in the SSI issuance has created a tremendous back log in the finalization of Medicare Hospital cost reports (Providers Qualifying for DSH).  We will be anticipating a deluge of finalized cost reports for the Spring and Summer of 2012.

From CMS E-mail:

An error was discovered and fixed in the bill discharge date edit logic for the Fiscal Year (FY) 2011 INP PPS PC Pricer. The update is for claims dated from 10/01/2010 to 09/30/2011.  The update is dated 07/26/2011.

Inpatient Rural Hospital Demonstration – Cost Settlement Methodology

Pub 100-19 Demonstrations; Trans. 77 – July 22, 2011

Summary of Changes:

This demonstration reimburses specific hospitals for Medicare inpatient services through cost based reimbursement. Eight hospitals are continuing from the initial 5-year demonstration period, mandated by section 410A of the Medicare Modernization Act. Eighteen new hospitals will be starting the demo starting with cost report periods beginning May 1, 2011 through January 1, 2012. This CR identifies the hospitals, MACs and legacy contractors, and defines the payment methodology.

QRS 1996 DSH MediKan Days – FY 1996

PRRB No. 2011-D24

The original hearing for this case was decided in 2007 (See PRRB Case No. 2007-D24). The case involves a General Assistance program in Kansas called MediKan. In the original decision the PRRB found that the MediKan program was included in the State of Kansas’ approved state plan under Title XIX, and that the MediKan program compensates hospitals that serve a disproportionately high number of low-income patients. As a result the PRRB found in favor of the Provider’s claim for these days to be included in the Medicaid patient day proxy.

The CMS Administrator overturned this original decision this decision and remanded the case back to the PRRB since there was no decision concerning the Hold Harmless provisions from CMS Program Memorandum A-99-62 (December 1999).

The PRRB ruled only on the Hold Harmless provision issue. Based on the evidence provided the PRRB found that the Fiscal Intermediary’s determination in the exclusion of the MediKan days was appropriate.