DSH SSI – Revised Ruling 1498-R2 – Toyon Client Memo

To:        Medicare DSH Appeal Clients

From:   Thomas P. Knight, President

Re:       Medicare DSH Appeal Update


We are pleased to report there has been a breakthrough on the Medicare SSI Ratio appeals for cost reports containing services prior to 10/1/04.  See the attached new ruling CMS-1498-R2 dated April 22, 2015.  This ruling has come about due to multiple court decisions related to Medicare DSH appeals.

Specifically, CMS has now published corrected SSI ratios on both a total patient day and covered patient day basis, and will allow Providers to choose which method they want to use.  Further, it appears that CMS will also allow Providers to realign their SSI ratios to their cost reporting period from the federal fiscal year basis normally used.  Further instructions regarding this are supposed to be released.

We are in the process of analyzing the new SSI ratios for all of our clients and will be identifying the best option for each facility.  We will also be requesting the supporting MedPar data for each applicable year to determine if there are any further discrepancies in the data as well as to determine whether realignment from federal fiscal year to hospital fiscal year is beneficial.

Please note that these corrected SSI ratios only apply to those fiscal years where an open Medicare appeal on the SSI issue exists or where the SSI Ratio appeal had been remanded to the Intermediary for action.

Upon completion of our initial review, we will notify each client of the potential reimbursement impact.  Due to the large number of clients, this will take a little while, but we will get it accomplished as soon as possible.

Toyon Associates Healthcare Finance


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