HFS News & Information

CMS published a preliminary Public Use File (PUF) for the FY 2021 wage Index May 17, 2019. This file reflects the Worksheet S-3, Parts II and III wage data from cost reports for Fiscal Year (FY) 2017 (FY Beginning from 10/1/16 to 9/30/2017).

The following file has been created and can be downloaded and used with the Wage Index Verification Tool for the Federal Fiscal Year 2021, Preliminary PUF:

FY_2021_Prelim_S3 wage tab_05172019.csv

The Centers for Medicare & Medicaid Services (CMS) released the final FY 2020 wage index data public use files (PUFs) on APRIL 30, 2019.  The files are available for the limited purpose of identifying any potential data entry or transmission errors made by CMS or the A/B Medicare Administrative Contractors (MACs), NOT for the initiation of new revision requests.   Hospitals should promptly review their final wage index data files and compare that to the data in the April 30, 2019 PUF to ensure that their Worksheet S-3 wage are accurate.  All requests from hospitals for corrections to their FY 2020 wage index data files must be submitted to and received (i.e., not postmarked) by both the A/B MACs and CMS on or before May 30, 2019.

The following file has been created and can be downloaded and used with the HFS Wage Index Verification Tool (located under Tools) for the Federal Fiscal Year 2020, April 30, 2019 PUF:

FY_2020_April 30 2019_S3_Data_PUF.csv

CMS published an updated Public Use File (PUF) for the FY 2020 wage index and occupational mix on 1/31/2019. This file reflects the Worksheet S-3, Parts II and III wage data from cost reports for Fiscal Year (FY) 2016 (FY Beginning from 10/1/15 to 9/30/2016). This data has been desk reviewed and verified by the MACs before being published.

The following file has been created and can be downloaded and used with the HFS Wage Index Verification Tool (located under Tools) for the Federal Fiscal Year 2020, January 31, 2017 PUF:

FY_2020_January_31_2019_S3_Data_PUF.csv

CMS published a preliminary Public Use File (PUF) for the FY 2020 wage Index June 5, 2018. This file reflects the Worksheet S-3, Parts II and III wage data from cost reports for Fiscal Year (FY) 2016 (FY Beginning from 10/1/15 to 9/30/2016).

The following file has been created and can be downloaded and used with the Wage Index Verification Tool for the Federal Fiscal Year 2020, Preliminary PUF:

FY_2020_Prelim_S3 wage tab_06042018.csv

CMS published the Proposed Rule Public Use File (PUF) for the FY 2019 wage index and occupational mix on 4/27/2017. This file reflects the Worksheet S-3, Parts II and III wage data from cost reports for Fiscal Year (FY) 2015 (FY Beginning from 10/1/14 to 9/30/2015). As noted in the wage index development timetable hospitals have the right to request corrections to their wage index data files if they can establish that the A/B MACS or CMS made a data entry or transmission error in the final FY 2019 wage index data files. A hospital requesting a correction must submit its request, by hard copy and email, along with complete, appropriate detailed documentation, to both its A/B MACS and CMS, no later than May 30, 2018.

The following file has been created and can be downloaded and used with the Wage Index Verification Tool for the Federal Fiscal Year 2019, Preliminary PUF:

FY_2019_April_27_2018_S3_Data_PUF.csv

Electronic signature of the Certification and Settlement Summary page of the Medicare cost reports

The Final Rule for the Fiscal Year 2018 update to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals was published in the August 14, 2017 Federal Register. The Final Rule included a provision for the electronic signature of the Certification and Settlement Summary page of the Medicare cost report. This provision is available as an option for cost reporting periods ending on or after 12/31/2017 in accordance with 42 CFR 413.24(f)(4)(iv).

HFS has been updating MCR system as CMS has released the transmittals to allow our users to electronically sign their MCR’s.   Users have several options on how to sign based on the flexibility built into the IPPS Final Rule and HFS has deigned options to maximize convenience. If the HFS user preparing the report has authority to sign the report, they can do so within the system. If the preparer is not the authorized signer they can specify the e-mail address of the authorized person and HFS, using our SaFE site, will facilitate the process of presenting the package to the authorized person and collecting the electronic signature. Signing can be accomplished on any device that has access to e-mail – yes, we have tested on our phones! For documentation and videos, please visit our website https://www.hfssoft.com/webinars/tutorials.

CMS Transmittals Issued include the following:

• Hospital 2552-10 – Implemented in T-13 for further information click here
• Skilled Nursing Facility 2540-10– Implemented in T-8 for further information click here
• Organ Procurement Organization 216-94– Implemented in T-7 for further information click here
• Home Health Agency 1728-94– Implemented in T-18 for further information click here
• ESRD 265-11– Implemented in T-4 for further information click here

In addition CMS is currently reviewing the HFS software for the following transmittals and we anticipate approvals shortly:

• FQHC 224-14 Transmittal 2
• Hospice 1984-14 Transmittal 3

Transmittals for the RHC 222-92 and CMHC 2088-92 have not yet been issued by CMS.

Option to electronically transmit their MCR through the Medicare Cost Report e-Filing (MCReF) system

While separate from the electronic signature of the Certification and Settlement Summary page of the Medicare cost report. CMS has announced a new option for the submission of Medicare Cost Reports. The new Medicare Cost Report e-Filing System or MCReF is not yet publicly availability but CMS has scheduled a training webcast to provide instruction for use of the new system. More information on the May 1, 2018 training webcast can be found at:

https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2018-05-01-Cost-Reporting.html

CMS presented an overview of the MCReF system to MCR vendors on 4/10/2018. The portal is nice and we think the provider community will find it convenient. The portal is designed to collect files for MCR submissions. This includes the EC (SN, HH, CM, HS, RF, OP, RD, FQ) PI, signed certification page, IRIS files if appropriate and other files that you would normally send to your MAC (Maybe .MCRX and .MCP files).

We encourage users to attend the CMS webcast. We will be in attendance and will continue to learn more about this process and make sure that we are doing everything we can to be compatible and supportive of the new process. Let us know if you have any questions and we will do our best to get answers.

If you have any questions, please contact Eric Swanson at eric@hfssoft.com.

CMS published an updated Public Use File (PUF) for the FY 2019 wage index and occupational mix on 2/2/2018. This file reflects the Worksheet S-3, Parts II and III wage data from cost reports for Fiscal Year (FY) 2015 (FY Beginning from 10/1/14 to 9/30/2015). These data will have been desk reviewed and verified by the MACs before being published. The following file has been created and can be downloaded and used with the Wage Index Verification Tool for the Federal Fiscal Year 2019, February 2, 2018 PUF:

FY_2019_February_2_2018_S3_Data_PUF.csv

Previously CMS issued Transmittal 12 to The Hospital and Hospital Health Care Complex Cost Report, Form CMS-2552-10. HFS provided a detailed overview of the T-12 and links to the CMS website at:

CMS issues Transmittal 12 to the Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10

HFS has been notified that CMS is in the process of issuing a Transmittal 13 for the hospital cost report, Form CMS-2552-10. The T-13 will reissue all content from T-12 and revises the effective date from cost reporting periods ending on or after August 31, 2017, to cost reporting periods ending on or after September 30, 2017. CMS anticipates T-13 will be issued by the end of this week.

We have also been notified that any hospital with a fiscal year ending on or after September 30, 2017, must submit using T-13. However, if a hospital with a fiscal year ending on or after September 30, 2017, has already submitted their cost report using T-11, it is not required to resubmit the cost report unless that provider is participating in the Rural Health Demonstration Project and/or has Nursing and Allied Health Education (NAHE) programs. All fiscal year ending September 30, 2017, cost reports will be final settled on the latest transmittal.

Additional HFS Note: There are two major revisions impacting Hospital with NAHE programs and hospitals reimbursed under the Rural Health Demonstration Project.

NAHE – T-12 modified instructions for Worksheet S-2, Part I, line 60 for nursing school and allied health education (NAHE) activities to separately identify each individual program reimbursed in accordance with the provisions of 42 CFR 413.85 where reimbursement is made on a reasonable cost basis. Details for each NAHE program will be reported on subscripts on line 60 and separate cost centers must be identified on Worksheet A for each program.

Rural Health Demonstration Program – CMS has added Worksheet E, Part A, lines 200 through 218 to calculate the §410A demonstration project payment adjustment amount for inpatient services. HFS previously accommodated this provision on HFS Worksheet E, Part H.

If you have any questions please contact eric@hfssoft.com.

The Hospital and Hospital Health Care Complex Cost Report, Form CMS-2552-10 was updated to Transmittal 12 by CMS, on November 17, 2017. Transmittal 12 is effective for cost reporting periods ending on or after August 31, 2017.

This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by including subsection (d) Puerto Rico providers as eligible for the electronic health record (EHR) incentive payments and by accommodating the Rural Community Hospital Demonstration Project (§410A Demonstration) adjustment. This transmittal also accommodates the ability for a provider to elect and sign the Certification and Settlement Summary page of the Medicare cost report using an electronic signature pursuant to the FY 2018 IPPS Final Rule.

Changes include:

Worksheet S:
• Added check box to the certification and settlement summary statement for electronic signature submission on cost reporting periods ending on or after December 31, 2017.

Worksheet S-2, Part I:
• Modified instructions for line 39 to reflect the revised eligibility criteria and corresponding low-volume adjustment of 25 percent, effective for discharges occurring on or after October 1, 2017.
• Modified instructions for line 60 for nursing school and allied health education (NAHE) activities to separately identify each individual program reimbursed in accordance with the provisions of 42 CFR 413.85 where reimbursement is made on a reasonable cost basis.
• Added lines 98 through 98.06 related to titles V and XIX reimbursement for critical access hospitals (CAH), reasonable compensation equivalents (RCE), and pass-through costs. These questions were previously addressed by HFS on a non-CMS Worksheet S-2. Part IX.
• Modified line 110 for the Rural Community Hospital Demonstration Project (also known as the §410A Demonstration), as extended by §15003 of the 21st Century Cures Act of 2016, to initiate the calculation of added lines on Worksheet E, Part A, lines 200 through 218, and Worksheet E-2, lines 200 through 215. This calculation was previously addressed by HFS on non-CMS Worksheet E, Part H.
• Added line 111 to identify providers participating in the Frontier Community Health Integration Project (FCHIP) Demonstration.
• Modified questions 167 and 169 to accommodate subsection (d) Puerto Rico providers eligible for the electronic health record (EHR) incentive payment for federal fiscal years 2016 through 2021, in accordance with the CCA 2016, Division O, Title VI, §602.

Worksheet S-3, Part I:
• Added line 33.01 to capture site neutral days and discharges for long term care hospitals (LTCH).

Worksheet A:
• Expanded the instructions for lines 20 and 23 (nursing school and paramedical education) programs to capture the costs of each program on a separate subscript of line 20 and/or line 23, as applicable.
• Added line 77 to capture allogeneic stem cell acquisition costs as defined in CMS Pub. 100-04, chapter 4, §231.11.
• Added line 93.99 to capture the costs of providing hospital-based partial hospitalization program (PHP) services as defined in §1861(ff) of the Act.
Worksheet A-8:
• Added instructions for line 19 to report the nursing school tuition offset adjustment and the allied health/paramedical education tuition offset adjustment. Note that tuition offset adjustments are to be made on Worksheet A-8 and not on Worksheet B-2.
Worksheets B, Part I and B-1:
• Shaded line 116 in columns 19, 21, and 22. This change prevents the allocation of Non-Physician Anesthetists and Interns and Residents costs to the hospital-based Hospice.

Worksheets D, Parts III and IV:
• Modified the worksheets by adding post step-down adjustment columns for nursing school and allied health. Post step-down adjustments were previously accommodated by HFS using non-CMS columns 11-13 on Worksheet D, Part III and non-CMS columns 21-24 on Worksheet D, Part IV
Worksheets E, Part A; E, Part B; E-2, E-3, Parts I through IV; H-4; J-3; M-3; and N-4:
• Added two lines to each reimbursement settlement worksheet to capture demonstration payment adjustments before sequestration, and demonstration payment adjustments after sequestration.

Worksheet E, Part A:
• Added a dedicated line 70.50 to capture the 410A demonstration project payment adjustment.
• Added lines 200 through 218 to calculate the §410A demonstration project payment adjustment amount for inpatient services.

Exhibit 4 (Low-volume adjustment):
• Modified the instructions to calculate the low-volume adjustment payment at 25 percent for services rendered on or after October 1, 2017.
• Shaded line 17.01 (net organ acquisition costs), to eliminate it from the low-volume adjustment payment calculation.

Exhibit 5 (Hospital acquired condition (HAC) adjustment):
• Shaded line 17.01 (net organ acquisition costs), to eliminate it from the HAC adjustment calculation.

Worksheet E, Part B:
• Added line 4.01 to capture the operating outlier reconciliation amount for operating expenses related to outpatient prospective payment (PPS) services.

•Worksheet E-1, Part II:
• Modified the instructions to accommodate the calculation EHR incentive payments for Puerto Rico subsection (d) hospitals in accordance with CAA 2016, Division O, Title VI, §602. This worksheet is not completed by original subsection (d) hospitals for cost reports beginning on or after October 1, 2016.

HFS is currently programming the software changes for transmittal 12 and anticipates approval in the near future. Once approved, HFS will make the update available to users of the software.

The transmittal is available at the CMS website:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017-Transmittals-Items/R12P240.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending

If you have any questions please contact eric@hfssoft.com.

We have received confirmation from CMS that they have granted an extension from October 31, 2017 until January 2, 2018 for all Inpatient Prospective Payment System (IPPS) hospitals to resubmit certain Worksheet S-10 data. For revisions to be considered, amended FY 2014 and FY 2015 cost reports, due to revised or initial submissions of Worksheet S-10, must be received by Medicare Administrative Contractors (MACs) on or before January 2, 2018. If an IPPS hospital whose FY 2014 or FY 2015 cost report has been final settled requests to revise Worksheet S-10 for that FY 2014 or FY 2015 cost report the request for reopening with the revised data must be received by January 2, 2018.

If you have any questions please contact Support@hfssoft.com.