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Tag: FY 2014

Noridian Tentative Settlements FYE 12/31/14 (Bi-Weekly Payments)

If you recently filed your cost report for FYE 12/31/14 and received a tentative settlement (assuming Noridian is your MAC), you may have been surprised to find out that the auditors included 27 bi-weekly payments in the cost report settlement. If your bi-weekly payment is small and simply covers the estimated bad debts, you may not have noticed the change. However, if you are one of the few hospitals that receive Periodic Interim Payments (PIP) for all Inpatient Medicare acute services you will have had a very significant surprise in the Medicare settlement.

In our follow-up with Noridian we were informed from Steve Milbrandt that:

“We switched from a manual summary of PIP and pass-through payments based on RA paid dates to an automated CMS system that summarizes PIP and pass-through payments based on invoice dates.  There are a few days difference between the invoice date and the RA date, and this caused providers with a 1/1/14 – 12/31/14 cost reporting period to have 27 bi-weekly payments.

The invoice date will now be used consistently to summarize payments based on the CMS mandated system, it will be used for all providers, and it will be used for all settlements (i.e. tentative, lump sum, final).”

When Noridian took over as the MAC in California, they chose to eliminate the beginning and ending accrual for the bi-weekly PIP payments. We reported this in our April 2014 report. The result of this change means that annually there will be 26 PIP checks that encompass 364 days of service (Each PIP Check reflects 14 days). Therefore there is a point in time where there will need to be a 27th PIP check due to the missing day each year and two days every leap year. This addition would occur once every 11 years.

We did not expect Noridian to implement a 27th PIP check in the second year of this process. For PIP hospitals, the impact to the FYE 12/31/14 booked settlement is likely over $1,000,000 impact. We have one provider we are working with now that is approaching $2,000,000 settlement impact. We are therefore continuing to appeal this change to include a 27 PIP check for these PIP hospitals and will let you know the outcome.

If you have a similar situation for your hospital, feel free to contact me (Ron Knapp) at 925-685-9312.

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Organ Procurement Program (OPO) and Tissue Typing Laboratory Cost Reports, Form CMS-216-914 to clarify and correct existing instructions

From: CMS Transmittal 6 (CMS-216-94) – 6/19/15

Summary of Changes:

This transmittal updates Chapter 33, Organ Procurement Organization and Tissue Typing Laboratory

Cost Reports, Form CMS-216-94 to clarify and correct existing instructions.

Revisions include:

  • Rounding standards for sequestration and kidneys
  • Worksheet S, Part I, modified instructions
  • Worksheet S, Part III, modified instructions
  • Worksheet A, modified instructions for lines 3 and 19 and removed line 20
  • Worksheets A-1, A-2, A-3, A-4 and A-5, modified and clarified instructions
  • Worksheets B/B-1, clarified instructions, removed line 15, and opened column 10A, reconciliation column, to properly adjust accumulated cost statistics
  • Worksheet C, Part I, clarified instructions
  • Worksheet C, Part II, clarified instructions
  • Worksheet D, clarified instructions
  • Supplemental Worksheet A-5-1, modified instructions
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Hospice Cost Report Forms Updated – Cost Reports on or after 10/1/14

From: CMS Transmittal No. 1 – 8/22/14


This transmittal introduces Chapter 43, Hospice Cost Report, (Form CMS-1984-14) which replaces the existing Form CMS-1984-99. The forms and instructions are revised in accordance with the statutory requirement for hospice payment reform in §3132 of the Patient Protection and Affordable Care Act (ACA), and to incorporate data previously reported on the Provider Cost Report Reimbursement Questionnaire, Form CMS-339.

Below is a summary of the cost reporting forms.

  • Worksheet S-2 incorporates data previously reported on the Provider Cost Report Reimbursement Questionnaire, Form CMS-339.
  • Worksheet A separately identifies general service costs.
  • Worksheets A-1 through A-4 identify direct patient care services by level of care.
  • Worksheets B and B-1 separately identify and allocate general service costs by level of care.
  • Worksheet C calculates per diem costs by level of care.
  • Worksheet F series provides for reporting of hospice financial data.

Hospice Cost Report Forms Updated – Cost Reports on or after 10/1/14

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