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Chances Are There’s More to Learn About Medicare Prospective Payment System Reimbursement

John Waltko, CPA
Vice President, Regulatory and Financial Reporting

Did you know……

  • Hospitals must comply with specific regulations before billing a new service under the hospital’s provider number?
  • Data reported incorrectly on the Medicare Cost Report can result in hospitals not qualifying for higher inpatient and outpatient reimbursements through the Medicare geographic filing process?
  • Hospitals located in rural areas have multiple opportunities to increase Medicare reimbursements?
  • All of Medicare programs reimbursement methodologies have common attributes?
  • Understanding Medicare reimbursement systems allows hospital finance personnel to develop sound net revenue budgets as well as product line net revenue projections and service line and hospital-wide feasibility studies?
  • Many private carriers are adopting Medicare reimbursement systems?

If you didn’t and you are the CFO, controller, finance or revenue cycle director or are new to the healthcare industry at an independent hospital or healthcare system, you will obtain critical Medicare reimbursement knowledge and expertise at an upcoming program I am teaching with my QHR Health colleague, Michael Donahue, AVP, Healthcare Finance and Reimbursement.

Improve Hospital Reimbursement

Dubbed QHR Health’s reimbursement experts, Mike and I teach a series of multi-day educational sessions to improve hospital reimbursements, including:

  • The Critical Access Hospital Reimbursement and Cost Reporting Boot Camp
  • Prospective Payment System Reimbursement & Medicare Cost Reporting Boot Camp
  • Reimbursement Cost Reporting and Reimbursement Webinar Series
  • Reimbursement and Regulatory Update Webinars

For example, Mike and I traveled to Idaho in June to teach the Critical Access Hospital Reimbursement & Medicare Cost Reporting Boot Camp. For three days, we taught CFOs, controllers, billing directors and revenue cycle managers the information needed to improve their Medicare reimbursements and financial operating results. To learn more about the Idaho program, click here.

Prospective Payment System Reimbursement & Medicare Cost Reporting Boot Camp

On August 22-25, Mike and I are offering a comprehensive Medicare reimbursement seminar at our offices in Brentwood, TN. During this four-day program, we will educate you about:

  • How hospitals and practitioners are reimbursed by the Medicare program,
  • Special reimbursements that allow hospitals to increase their Medicare reimbursements,
  • An overview of other sub-acute care providers and other providers’ reimbursement systems and
  • How to compile a Medicare cost report.

We start with a detailed discussion about the Medicare inpatient and outpatient prospective payment systems and the Medicare physician fee schedule system and then expand to how reimbursements are determined on a claim-by-claim basis. From here on day two, we review the multiple Medicare program hospital designations that allow additional reimbursements IF the hospital qualifies such as Sole Community Hospital designations and Medicare Geographic Reclassification.

Of course, we cover the qualification criteria for each designation and related Medicare cost report worksheets. Mike and I also discuss other unique reimbursements such as Medicare indirect medical and graduate medical education, highlight prospective payment systems (PPS) for multiple other provider types including psychiatric hospitals/units and select outpatient provider types, e.g., ambulatory surgical centers (ASCs).

Over the course of a day and a half, we review the Medicare cost report forms and compilation process. It is far from pretty, and many sections of the cost report are informational reporting only for the Medicare program. But there are still reporting aspects that can cause a Medicare settlement, such as Disproportionate Share Hospital (DSH), Uncompensated Care Reimbursement, Indirect Medical Education and transplant programs.

In case you did not realize it, states providing Medicaid DSH and supplemental ‘tax and match’ reimbursements utilize the Medicare cost report for purposes of determining hospital-specific Medicaid DSH and Supplemental Programs Upper Payment Limits. Errors within the cost report can negatively impact these reimbursements.

By the end of the session on cost reporting forms, participants can:

  • Identify the most critical cost reporting worksheets that impact hospital reimbursements and
  • Know how to complete the forms.

Chances are, if you join us for the PPS Reimbursement & Medicare Cost Reporting Boot Camp, you will identify additional Medicare reimbursement for your hospital.

Additional resources for finance, reimbursement and rev cycle professionals are: