Medicare Cost Report Basics - tfcassociation.com · ©2015 MFMER | slide-1 Medicare Cost Report...

©2015 MFMER | slide-1

Medicare Cost Report Basics: Information for the TFC

Robert Howey, CPA Revenue Cycle Manager

Transplant Financial Coordinators Association Workshop September 30, 2015


Tell me and I forget Teach me and I remember Involve me and I learn.

- Benjamin Franklin


Objective

After the session, you will be able to:

• Understand the preparation of the cost report and types of

costs included/excluded

• Understand the Medicare cost report reimbursement

methodology


Agenda

I. Medicare Cost Report Overview

II. Types of Organ Acquisition Costs

III. Medicare Reimbursement Methodology


Medicare Cost Report Overview


• What is a Medicare cost report?


• What is a Medicare cost report? • Why is it important?


• What is a Medicare cost report? • Why is it important? • What are organ acquisition costs?


Generally, represents the necessary and reasonable costs attributable to acquiring an organ and preparing the potential donor and transplant recipient for organ transplantation.


I II III IV

Evaluation Maintenance Transplant Surgery

Post-Transplant

ORGAN ACQUISITION FOR RECIPIENTS

ORGAN ACQUISITION FOR LIVE DONORS1

PRE-TRANSPLANT

1Effective 11/28/11, excludes post-discharge complications


Types of Organ Acquisition Costs


Organ Acquisition Costs

Direct


Direct Organ Acquisition Costs Dedicated Support Personnel (examples): • Administrator/Manager

• RN Coordinator

• Social Worker

• Dietitian

• Financial Coordinator

• Appointment Schedulers

• Database Administrator

• Medical/Surgical Director


Direct Organ Acquisition Costs

If not 100% organ acquisition activity,

complete a TIME SURVEY.


Direct Organ Acquisition Costs Other Direct Costs (examples): • OPO organ fee • Transplant registry fees (UNOS only) • Tissue typing of donor and recipient • Physician preadmission transplant evaluation • Other external diagnostic testing • Transportation costs for organ retrieval • Surgeon procurement fee • Other departmental costs


Direct Organ Acquisition Costs NOT considered OAC: • Burial expenses for deceased donor • Costs for organs sent outside the U.S. • Living donor travel • Services related to treatment for the underlying

disease

SOURCE: PROVIDER REIMBURSEMENT MANUAL (PUB. 15-1), SECTION 2773B



Direct

Hospital Services


Hospital Services


TRANSPLANT RECIPIENT SERVICES

MEDICARE NON-MEDICARE HOSPITAL PHYSICIAN HOSPITAL PHYSICIAN

Pre-Transplant

Write-off charges and capture for cost report Reimbursed via C/R

Bill to transplant hospital

Bill to Payer Capture charges for cost report


Transplant I/P Episode

Bill to MAC Reimbursed DRG

Bill to Carrier Reimbursed via Fee Schedule

Bill to payer

Bill to payer

Post-Transplant

Bill to MAC Reimbursed APC

Bill to Carrier Reimbursed via Fee Schedule

Bill to payer Bill to payer


TRANSPLANT LIVE DONOR SERVICES

MEDICARE NON-MEDICARE HOSPITAL PHYSICIAN HOSPITAL PHYSICIAN

Pre-Transplant



Write-off charges and capture for cost report Reimbursed via SAC

Bill to transplant hospital Reimbursed via SAC

Transplant I/P Episode


Bill to Carrier w/ Q3 modifier Reimbursed via Fee Schedule


Bill to recipient’s payer

Post-Transplant Follow-Up





Post-Discharge Complications (effective 11/28/11)

Bill to MAC Reimbursed via IPPS/OPPS Occ Code 36 Pat Rel Code 39





Pre-Transplant Charge Flow: Recipients

Y

N

N

Y

N

Y



Direct Hospital Services

Overhead


Common OAC Overhead Costs

• Space (Square Footage)

• Building

• Equipment

• Plant Operations

• Housekeeping


Common OAC Overhead Costs

• Employee Benefits (Salaries)

• Cafeteria (FTEs)

• Administration (Accumulated Cost)

• Accounts Receivable (Gross Charges)

• Medical Records (Gross Charges)

• Nursing Administration (Nursing FTEs)

• Social Services (Time Spent)


Allowable Or

Non-Allowable?


Medicare Reimbursement Methodology


Medicare Reimbursement

X Medicare Usable Organs

Total Usable Organs

Medicare Organ Acquisition

Reimbursement

Medicare Ratio


Medicare Ratio

Medicare Usable Organs Total Usable Organs

Medicare Primary Transplants Total Transplants

Medicare Secondary Transplants (if Medicare had some liability)

Deceased Donor Organs

Organs Sold to Other Hospitals (e.g, Paired Exchange)


Takeaways • Accounting for TFC costs:

• Salary/Benefits • Space • Other overhead

• Review policies/procedures • Donor/recipient financial responsibility • Medicare transplants


Let’s Stay in Touch!

Robert Howey (904) 953-2698

[email protected]


Citations for Organ Acquisition • Paper Based Manuals

• Provider Reimbursement Manual, Part I, Chapter 27

• Internet-Only Manuals (IOM) • Medicare Benefit Policy Manual (Pub. 100-02, Chapter

11, Section 140) • Medicare Claims Processing Manual (Pub. 100-04,

Chapter 3, Section 90)

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/index.html

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