Potential Issues with PS&R Report 118 Medicare Days

We have observed issues with the Medicare Managed Care days from PS&R Report 118, while working with numerous providers on recent cost report filings. We recommend all providers review any recently generated PS&R summary reports to ensure there are no issues with the Medicare Managed Care days from PS&R Report 118 and potentially re-run new PS&R summary reports to correct any issues.

 

CMS recently released 05.15.02, addressing PS&R Enhancement 1319 (PS&R updated to purge Rejected claims in conjunction with CR 12251). The following is a description of the issue/resolution:

 

“Prior to 10/4/2021, FISS was sending rejected claims to PS&R in the Paid Claim File (PCF). The rejected claims caused discrepancies between the Medicare Days and Accommodation Units on the PS&R 118 Report which in turn had the potential to cause an overstatement of Medicare Days on provider cost reports. Due to this problem, CMS issued CR 12251, instructing FISS to no longer send rejected claims to PS&R (with exception of certain RAC PIP non-paid claims). FISS implemented this CR on 10/4/2021 which resolved the issue for prospective claim loading/reporting into PS&R. However, the historical rejected claims which were loaded into PS&R still needed to be purged (made to no longer be reportable) such that they no longer caused the discrepancy described above on PS&R reports. With the implementation of this enhancement, all Rejected claims have been purged from PS&R reporting.”

 

Please reach out to Matthew Beymer at matt.beymer@toyonassociates.com or Sherry Collins at sherry.collins@toyonassociates.com for any additional cost report questions. They can also be reached at (888) 514-9312.

 

Thank you,

 

Toyon Associates, Inc.