Some providers could see significant changes to their Medicare reimbursement come October 1, 2017, when the Centers for Medicare & Medicaid Services (CMS) will start paying providers their 2018 Inpatient Prospective Payment System (IPPS) rates. Significant items to note include changes to Uncompensated Care (UCC) payments, Low-Volume Adjustments (LVA), and Medicare Dependent Hospital (MDH) reimbursement.
UCC Payments: In Federal Fiscal Year (FFY) 2018, the UCC calculation will, for the first time ever, utilize the unaudited Worksheet S-10 from the Medicare cost report. Additionally, the methodology to disperse UCC funds for FFY 2018 will use:
- Medicaid days from Medicare cost reports for 2012, 2013, and 2014.
- 2015 Supplemental Security Income (SSI) ratios.
- 2014 Worksheet S-10 data.
Depending on state Medicaid expansion, this change in reimbursement methodology may significantly impact providers. Because this calculation has been modified, CMS will allow revisions to Worksheet S-10 for cost reporting periods beginning in FFY 2014 and FFY 2015. The revised Worksheet S-10s should be submitted to the Provider’s Medicare Administrative Contractor (MAC) by September 30, 2017.
LVA: The FFY 2018 IPPS Final Rule allows the temporary LVA provider adjustment (via the Affordable Care Act [ACA]) to expire September 30, 2017. Within the ACA, LVA expanded reimbursement to providers that were 15 miles away from another hospital, and had less than 1,600 Medicare discharges. With the expiration of the ACA’s temporary LVA adjustment, hospitals now must be located more than 25 miles from another hospital, and have fewer than 200 total discharges to qualify for the LVA in 2018. Based on the FFY 2018 IPPS Final Rule and FFY 2017 IPPS – Final Rule – Correction Notice, the expiration of this adjustment will reduce reimbursement for more than 600 providers from 2017 to 2018.
MDH: The MDH program also expires September 30, 2017. If providers with MDH status met the Sole Community Hospital (SCH) qualifications, they could have applied for SCH status on or before September 1, 2017. If a MDH provider missed the application deadline, then the SCH status will be effective 30 days after CMS written approval.
If you are interested in determining your hospital’s estimated Medicare reimbursement per discharge using FFY 2018 IPPS rates, revising your Worksheet S-10s by the September 30 deadline, or applying for SCH status, contact PYA’s reimbursement experts (Lori Foley, Butch Bullock, Lisa Scott, or Jonathan Skaggs) at (800) 270-9629.