November 21, 2023

Top Questions from the S-10 Updates Webinar

Looking for more information about S-10 Updates? BESLER’s Director of Reimbursement Services Christina Brown answers your questions from the recent webinar.

To watch Christina’s S-10 Updates Webinar, click HERE.

One of the issues we found is that in actions taken (System Adjustment, correcting errors) after the listing was submitted, the auditor is saying these were claimed outside the cost reporting period, when in fact they were claimed properly, and we have to write an explanation of this. Is there a way we can get avoid these?

S-10 is based on post date, so the correct thing to do would be to report everything in the period that it occurs. For example, if there is a write-off in one cost reporting, then there is an adjustment to reverse it in the next period, then the reversal would need to be reported in the subsequent cost reporting period.
Does the insured charity account have to have a 3rd party payment on it to be considered insured?

Yes, it does. We have seen in audits those records being moved to uninsured.
For the amounts shown (like on slide 10) – what year(s) are these applicable?

The numbers on the slides correspond with the links on the previous slides, and slide 10 which comes from the FY2024 IPPS Final Rule. These rates are derived from previous years filings (2018, 2019, and 2020) and data.
In New York, would other state governments include the Essential Plans?

Please see the instructions for line 13:
Enter all payments received or expected for services delivered during this cost reporting period for patients covered by a state or local government indigent care program (other than Medicaid or CHIP), where such payments and associated charges are identified with specific patients and documented through the provider’s patient accounting system. Include payments for all covered services except physician or other professional services, and include payments from managed care programs. Based on this, I believe lines 13-16 would be the appropriate location to report Essential Plans.
In order to tie patient demographic to transaction listing, does the criteria for patient demographic need to be by admit and transaction listing by post date and to cut date by year end? Thank you.

The patient demographic file would be based on a snapshot in time, so if you’re 12/31, you would want to pull that information as close to the beginning of the year as possible for all admit/discharges. Transaction detail would be pulled based on post date, which would be 12/31.
Now S-10 shows Part 1 and Part II as she explained. What does hospital complex refer to? I’m unclear on what is the difference between part 1 & 2.

Hospital Complex for Part I would encompass all provider/sub-providers on your cost report, while Part II is for hospital only patients. So Part II would not include Psych, Rehab, SNF, HHA, etc. patient types.
Are we permitted to include the 35% of the Medicare bad debts that are not paid in S-10?

The support for line 26 would be total hospital bad debt. Any Medicare bad debt is reported separately. I think you are asking if you can split the write-off and claim the non-reimbursed Medicare bad debt and claim them differently. Then answer to that is no.
The detail would only be needed when they sample the account during audit. Wouldn’t we just need the data on the account that was written off during the FYE?

Total patient detail that was written off during the cost reporting period is required and will need to be reported in the appropriate exhibit format covered during the presentation. For audit samples, it is possible you could have to provide more than what is required for the exhibits.
What did you say the variance % should be between BD/CC and GL?

We like to keep the variance to no more than 3-5% at most when comparing the summary transactions of bad debt and charity write-offs to the GL.
What is included with hospital complex?

The Hospital Complex reported on Part I would be inclusive of all provider/sub-providers on the cost report. Thus, Part I includes all that was included before, such as Hospital, Psych, Rehab, SNF, HHA, etc.
What is the Transmittal# for the new Transmittal 21 final that was released.
R21P240i. Here is the link: https://www.cms.gov/regulations-and-guidance/guidance/transmittals/2023-transmittals/r21p240i