May 5, 2022

Top Questions from the S-10 101 Webinar

Christina Brown, BESLER

Looking for more information about Worksheet S-10? BESLER Reimbursement Manager, Christina Brown, answers your questions.

To listen to Christina’s “S-10 101” webinar, click HERE.

Do you have any specific recommendations for hospitals that use recurring accounts?

If you mean you use accrual accounts on your GL, then the amounts should still be close. If not, I would list as a reconciling item on your reconciliation. If you are asking about patients or something else specific, you may reach out to me directly.
Does this webinar relate to CAH hospitals?

Worksheet S-10 relates to the Uncompensated Care calculation. CAHs do not receive Medicare DSH reimbursement, but it’s still important for proper reporting of S-10 since it calculates Uncompensated Care. Get more specific information pertaining to CAHs on the CMS website.
For Worksheet S-10, Line 2.00, should Net Revenue from Medicaid include out-of-state Medicaid patient data? (e.g., hospital located in Virginia sees a patient from North Carolina)
The Medicaid section is for all title XIX services received or expected to be received during the cost reporting period.
If Medicare bad debt listing for FYE 03/31/2022 was already in the new format, do we have to change it? Will it affect us?

No. The only stipulation is if you have an auditor that requests a specific format, then you may have to reformat your data at audit.
Is bad debt when it was sent to collection or back from agency?

It is when the amount is written off to Bad Debt on the patient account.
Is the worker’s compensation for uninsured the self insurance (employee) worker’s compensation? Can you expand on this?

It would be anything with a Worker’s Compensation financial class as identified in the patient demographics. Self insurance (employee) would be a different financial class.
Can you expand on what you said about the ratio for professional fees?

If there are any professional fees reported/included in the hospital billing, than any write off amounts reported relating to those fees must be excluded. If there is not a way to differentiate what part of the write off relates to those fees, then the best practice would be to reduce the amount of the write off by the ratio of total charges to professional fees.
Where are HRSA COVID-19 payments reported?

These patients should not be on S-10 as they would not have Charity or Bad Debt write offs. COVID-19 PHE Funding is reported on G-3 line 24.50.
We frequently have patient refunds returned due to bad address so the total payments including charity care and bad debt are more than the charges. Any advice on how to handle?

The WO amount cannot exceed the charges. In those cases, we simply reduce the WO amount. If you have a credit balance on an account, it could get flagged in an audit. You could either explain the circumstance during audit, or you could report it as an adjustment.
We have an HRSA insurance plan, but the services are not always paid by HRSA. We are required to exclude those patients that have an HRSA payment, but what about those accounts that have not been paid in the cost report year, but may have a BD or charity transaction in the account?

Yes, HRSA should be excluded and could potentially get flagged at audit. I would suggest, if you anticipate to receive payments, that you exclude from your population.
Did you say to include workers comp and auto as uninsured for lines 20 to 23, column 1?
Yes.
Is a detail report of the total bad debt on line 26 required when you file the cost report? The charity log detail (line 20) is included with the filed report, but the bad debt detail log is usually only requested during the S-10 audit.

We file with detail for both. Proposed T17 had a required form, so I anticipate another version will be released subsequently. It’s best just to have one ready at filing.
Should inpatient psych units, inpatient rehab units, and home health agency charges be excluded from the S-10?
This treatment was released in the draft instructions with Proposed T17, but was removed in the final version. At this time, we are only excluding charges for Physician/Professional Fees.
Regarding proper reporting of Charity & Uninsured Discounts between Col. 1 vs Col. 2, PY auditors have asked us to report any insured Pt Charity write-offs in Column 1-Unins Pts, unless write-offs of the Pt Liab Copay/Coins/Ded + the one exception for Medicaid benefit loss exceeded.
We have not encountered an auditor that has gotten this specific. It is important to have a specific Charity Policy and that anything written off for Charity follows that policy.
How are you reporting a patient account that has both an Insured Charity w/o and an Uninsured Charity w/o?
We would assume that if the patient demographics reports the patient as an insured patient, and if insurance payments were received, that the write off would follow the Charity policy, and therefore the write off amount would be reported in column 2 as Insured.
How are accounts related to sub providers handled?
If it is included in the Cost Report, then we include those patients. In the draft instructions released with proposed T17, there were instructions to exclude Psych, SNF, and HHA patients. However, in the final rule published in January, the verbiage in the instructions was removed. At this time, we are only excluding charges related to Physician/Professional fees.
Regarding Line 26 Total bad debt expense for hospital: Should this amount tie to the bad debt expense on the Audited financial statement?
It should be close (we like to see 3% or lower variance, but no more than 5%). We start with a reconciliation of Bad Debt write off transactions posted in the current year to Bad Debt expense reported on the GL. We then show any reconciling items that would bring us close to our variance threshold.
We see a large volume of inmates. Some are covered under Medicare and Medicaid, but there are some that are not, and we have written off the amounts to charity care. Is this the correct category for uninsured inmates? Or, should it be Non-Medicare Bad Debt?
I would confirm this is somehow accounted for under your Charity Policy, but I would agree with the uninsured charity treatment.