The Centers for Medicare and Medicaid Services (CMS) recently released Med Learn Matters SE19015 that reminds hospitals of the new requirement to provide supporting documentation on filed cost reports.

The Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) Final Rule (August 17, 2018, Federal Register Vol. 83, No. 160 starting on page 41677) specified the required supporting documentation that must be submitted with the Medicare cost report. This change applies to cost reporting periods beginning on or after October 1, 2018.  Medicare Administrative Contractors will reject filed cost report submissions that do not include the required documentation.

These documentation requirements may apply to your facility:

Charity Care and Uninsured Discounts claimed on Worksheet S-10

DSH-eligible hospitals reporting charity care and/or uninsured discounts must include support with a detailed listing of charity care and/or uninsured discounts that corresponds to the amounts claimed in the filed cost report. Hospitals must submit a charity care and/or uninsured discount list that supports the amounts reported in its cost report including information such as patient name, dates of service, insurer (if applicable), and the amount of the charity care and/or uninsured discount given to the patient. CMS promised that it will eventually provide a standard format for reporting the charity/uninsured discounts.

Disproportionate Share Hospital (DSH) Eligible Hospitals

For hospitals claiming a DSH payment adjustment, a cost report must include a detailed listing of the hospital’s Medicaid-eligible days that corresponds to the days claimed in the hospital’s cost report. If the hospital submits an amended cost report that changes its Medicaid-eligible days, it must submit an amended listing or an addendum to the original listing of the hospital’s Medicare-eligible days that corresponds to the days claimed in the hospital’s amended cost report.

Medicare Bad Debts

For providers claiming Medicare bad debt reimbursement, a cost report will be rejected for lack of supporting documentation if it does not include a detailed bad debt listing that corresponds to the amount of bad debt claimed in the provider’s cost report. CMS continues to require that hospitals use the exhibit from CMS-339 form to report bad debts.

Teaching Hospitals

Teaching hospital’s cost report will be rejected for lack of supporting documentation if the cost report does not include the Intern and Resident Information System (IRIS) data.

Home Office Cost Allocations

Hospitals that claim costs from a home office or chain organization must submit the home office or chain organization’s Home Office Cost Statement that supports the related party cost. For hospitals with a different FY end from the home office or chain organization, CMS states: “when the provider and its home office have differing fiscal year ends, the provider’s home office costs for a portion of the cost reporting period (as reflected on the Home Office Cost Statement) must correspond to a portion of the amount reported in the provider’s cost report.”

If you have questions about these new requirements, please reach out to a member of the Blue & Co. Hospital Reimbursement Group.