Hospital and Hospital Components Identified on Worksheet S ...



Hospital and Hospital Components Identified on Worksheet S-2, Lines 1-16

1. FACILITY: Facility refers to the hospital and all hospital-based components such as Subprovider, Skilled Nursing Facility (SNF), Nursing Facility (NF), Home Health Agency (HHA), Intensive Care Facility/Mental Retardation (ICF/MR), and Hospice.

1a. Hospital: An institution with the primary function of providing inpatient services,

diagnostic and therapeutic, for a variety of medical conditions, both surgical and non-surgical. Most hospitals provide some level of outpatient services, particularly emergency care.

2. Subprovider: This is a portion of a general hospital which has been issued a

subprovider identification number because it offers a clearly different type of service and cost from the hospital.

3. Swing Bed SNF: This is a rural hospital with fewer than 100 beds that is approved by HCFA

to use these beds interchangeably as hospital and Skilled Nursing Facility beds with payment based on specific care provided.

4. Swing Bed NF: This is a rural hospital with fewer than 100 beds that is approved by HCFA and by the State Medicaid Agency to use these beds interchangeably as hospital and other nursing facility beds, with payment based on the specific level of care provided. Swing bed NF Services are not payable under the Medicare program but are payable under State Medicaid programs if included in the Medicaid State Plan.

5. Hospital-Based This is a distinct part that is primarily engaged in providing skilled nursing

Skilled Nursing care and related services to residents who require medical or nursing care,

Facility (SNF): or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. SNFs are commonly referred to as nursing homes.

6. Hospital-Based This is a distinct part nursing facility which has been issued a separate

Nursing Facility identification number . Nursing facilities only provide services to

(NF): Medicaid (Title XIX) patients.

6a. Intensive Care This is a distinct part facility which has been issued a separate

Facility/Mental This is a distinct part facility which has been issued a separte

Retardation identification number. ICF/MRs only provide services to Medicaid

(ICF/MR): (Title XIX) patients.

7. Hospital-Based An HHA provides services to patients in their homes. This is a distinct

Home Health part facility which has been issued a separate identification number.

Agency (HHA):

8. Certified This is a distinct entity that operates exclusively for the purpose

Ambulatory of providing surgical services to patients not requiring hospitalization.

Surgical Center This is not reimbursed in the Medicare cost report;

(ASC): however, the amount of overhead allocated to it is in the cost report.

8a. Hospice: An organization that is primarily engaged in providing care to terminally ill individuals. This is not reimbursed in the Medicare cost report; however, the amount of overhead allocated to it is in the cost report.

8b. Rural Health

Clinic (RHC): A clinic that provides various covered services.

8c. Federal

Qualified

Health Cntr. FQHC’s are mainly community health centers, Indian health clinics,

(FQHC): migrant worker health centers, and health centers for the homeless.

.

8d. CORF: Comprehensive Outpatient Rehabilitation Facility

8e. CMHC: Community Mental Health Center

8g. OPT: Outpatient Physical Therapy

8h. OOT: Outpatient Occupational Therapy

8g. OSP: Outpatient Speech Pathology

8h. Renal Dialysis: This line is for both satellite renal dialysis numbers and hospital based renal dialysis facilities.

Other Terms:

8i. Sole Community A hospital that is located more than 35 miles from other like hospitals, or it’s

Hospital (SCH): located in a rural area and meets one of the criteria mentioned in CFR 412.92.

CFR 412.92 is the criteria for Sole Community Hospitals.

8j. Medicare A hospital that has 100 or fewer beds during the reporting

Dependent period and at least 60% of the hospital’s inpatient days or

Hospital (MDH): discharges were attributable to individuals receiving Medicare Part A benefits during the reporting period.

General Information:

9. Some fields have an “X” as either the Line or Column designation. An example is the number of months in the cost reporting period (F24). Although it does not appear on the cost report, we calculate it from cost report data to ease analysis.

10. File Creation Date (F69) and System Identification (F70)

These fields are primarily for internal use only. F69 represents the date that the Medicare fiscal intermediary extracted HCRIS data from the cost report. F70 enables HCFA to more quickly identify and resolve system errors.

11. Medicare Utilization Indicator (F75)

The Medicare Utilization Indicator identifies how the hospital filed its cost report. An L stands for a hosptial that has low Medicare utilization, an N stands for a hospital that has no Medicare utilization. This field also identifies the most common type of cost report, the Full Medicare cost report (F). All Low or No Medicare Utilization cost reports are authorized by the hospital’s fiscal intermediary and defined in Section 2414.4 of the Provider Reimbursement Manual. Generally, the FI makes a determination of utilization based on Total Facility Costs to Total Medicare Costs, Total Facility Charges to Total Medicare Charges, and Total Facility Days to Total Medicare Days.

Under Section 2414.4 of the Provider Reimbursement Manual, a low or no utilization provider may file its cost report in an abbreviated form. So these reports will not contain values in most fields of the Minimum Data Set.

Data files of each of these abbreviated cost reports will contain certain identifying information and some cost report data as specified below.

The values for field F75 may be either “L”, “N”, or “F.”

N = No Medicare utilization report will have data present in up to 8 fields (F1, F22-F24, F69, and F72-F74).

L = Low Mediare utilization report can have data in the following fields (F1, F22-F25, F69, F72-F74, F85, F115, F153, F172, F178, F1843, F1938, F1990, F1844, F1939, F1991, and F2146).

In addition, hospitals reimbursed under the PPS Method will have Wage Index Information from Worksheet S-3, Part II.

F = All Other Medicare Cost Reports are Full Medicare Utilization.

Explanation of Fields:

12. Beds Available (F78-F92) are those available for use by patients at the end of the cost reporting period.

13. Bed Days Available (F93-F106) is based on statistics throughout the cost reporting period. It is equal to the number of beds (excluding newborn) available times the number of days.

14. Fields 361 through 440: These are the total salaries for each cost center before reclassifications and adjustments. These costs come directly from the provider’s accounting books and records. These costs

are the total costs for the entire facility complex.

15. Fields 441 through 527: These are the total Other Costs for each cost center before reclassifications and adjustments. These costs come directly from the provider’s accounting books and records. These costs are the total costs for the entire facility complex.

16. Fields 528 through 611: These are the total reimbursable costs after reclassifications and adjustments for each cost center. The salaries and other costs in numbers 14 and 15 above are added together for each cost center and then reclassified and adjusted as needed. These costs are before cost allocation and represent costs for the entire facility complex.

17. Fields 612 through 616: These fields represent the direct costs and the indirect costs for the medical education cost centers. Direct costs are costs from the provider’s accounting books and records and in this case after reclassifications and adjustments (number 16 above). Indirect costs are the overhead costs that were allocated to these medical education cost centers.

These costs are for the entire facility complex.

18. Fields 617 through 678: These are the total costs after cost allocation for each cost center. These costs include both direct and indirect costs (same explanation in number 17 above for direct and indirect costs). These costs are for the entire facility complex.

19. Fields 681 through 727:. These costs are after cost allocation and include both direct and indirect costs and the excess amounts above the RT/PT limits and the RCE limit, since PPS hospitals are not subject to these limits. These costs are only used to calculate the cost to charge ratio for PPS hospital services. Also, these costs are for the entire facility complex.

20. Capital and Operating Cost

Reduction Amounts Outpatient cost to charge ratios are computed differently than the (Fields 728 and 729) Inpatient cost to charge ratios. The cost portion in the outpatient cost to charge ratio is after the subtraction of the Capital Reduction amount and the Operating Cost Reduction amount; whereas the cost portion of the inpatient cost to charge ratio is not reduced for capital or operating costs. Also, the outpatient cost to charge ratio computation does not depend on the type of reimbursement method of the hospital.

Field 728 represents the total capital reduction amount for all the cost centers. Field 729 represents the total outpatient cost reduction amount for all the cost centers. These costs are for the entire facility.

.

21. Hospital Complex Inpatient Cost/Charge Ratios (Fields 806 through 836)

The hospital inpatient cost to charge ratios are computed for each ancillary cost center, outpatient, and other reimbursable cost centers. The inpatient ratio computation depends on the type of Medicare cost reimbursement method of the hospital (PPS, TEFRA, Cost/Other methods). The ratio is computed by dividing the facility’s total costs by the facility’s total charges for each cost center.

Cost/Other Method of Reimbursement

Hospitals reimbursed under the Cost/Other Methods are subject to the Respiratory Therapy, Physical Therapy, Occupational Therapy, and Speech Pathology (RT/PT/OT/SP) adjustments and the RCE Disallowance adjustments. The RT/PT/OT/SP and RCE Disallowance adjustments are the amounts in excess of the limit set by HCFA. Medicare does not pay these amounts in excess for hospitals reimbursed under the Cost/Other Methods. Fields 629-655 and 657-659 are to be used in the numerator of the cost to charge ratio since these fields have been adjusted for RT/PT/OT/SP and RCE Disallowance adjustments.

Cost to Charge Ratio Worksheet B, part I, column 27 (for each cost center) For Cost or Other =’s Fields 629-655 and 657-659 Method Worksheet C, part I, column 6 (Fields 742-766, 768, 769, 771-773)

plus

Worksheet C, part I, column 7 (Fields 774-798, 800, 801, 803-805)

TEFRA Method of Reimbursement

Hospitals reimbursed under the TEFRA method are not subject to the RT/PT/OT/SP adjustments so Medicare will pay the amount in excess of the limit. TEFRA hospitals are still subject to the RCE Disallowance adjustment.

Since TEFRA hospitals are not subject to the RT/PT/OT/SP adjustments, these adjustments must be added back into fields 641, 642, 643, and 644. Field 679 represents the RT adjustment and must be added to Field 641; Field 680 represents the PT adjustment and must be added to Field 642; Field 680A represents the OT adjustment and must be added to Field 643; Field 680B represents the SP adjustment and must be added to Field 644.

TEFRA =’s Worksheet B, part I, column 27 (for each cost center)

Fields 629-655 and 657-659

[make adjustments to fields 641, 642, 643, 644 as explained above] Worksheet C, part I, column 6 (Fields 742-766, 768, 769, and 771-773)

plus

Worksheet C, part I, column 7 (Fields 774-798, 800, 801, 803-805)

PPS Method of Cost Reimbursement:

Hospitals reimbursed under the PPS method are not subject to the RT/PT or the RCE Disallowance adjustments so Medicare will pay the amounts over the limits.

Fields 693-720, 722-724 represent total costs with both adjustments added back in for each cost center and are to be used in the numerator of the cost to charge ratio.

Cost to Chare Ratio Worksheet C, part I, Column 5 (for each cost center)

For PPS Fields 693 - 720, 722-724

Method Worksheet C, part I, column 6 (Fields 742-769, 771-773)

plus

Worksheet C, part I, column 7 (Fields 774-801, 803-805)

22. Outpatient Cost to Charge Ratios (Fields 837 through 867)

Outpatient Cost to Charge Ratio =’s Worksheet C, part II, Column 6 (for each cost center) [not in this data set] Worksheet C, part I, column 6 (Fields 742-769, 771-773)

plus

Worksheet C, part I, column 7 (Fields 774-801, 803-805)

*** Note: Worksheet C, part II, Column 6 comes from Worksheet B, Part I, Column 27

(Fields 629 - 659) minus the capital and operating cost reduction amounts for each cost center.

This data set, however, does not contain the operating and capital reduction amounts for each cost center. It only contains the total capital and operating reduction amounts for the entire facility (Fields 728 and 729).

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