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Knowledge
Center
SSI Realignments
A recent change in regulations regarding the realignment
of Supplemental Security Income (SSI) ratios for Disproportionate Share
Hospitals (DSH) presents a significant opportunity for hospitals to
potentially increase their DSH reimbursements. Here's a summary of key
points and actions hospitals can take:
- 1. SSI Realignment Rule Update:
- Hospitals can now request a realignment of their SSI ratio for any year, past or present,
without being limited to the previous three years after the issuance of
the Notice of Program Reimbursement (NPR). This adjustment is possible
at any time as per 42 CFR 412.106(b)(3).
- 2. Impact on DSH Reimbursements:
- The SSI ratio (Medicare fraction) is an essential
factor in determining DSH payments. A higher SSI ratio (more days for
patients eligible for both Medicare and SSI) leads to higher DSH
reimbursements.
- Hospitals whose fiscal year does not align with the
Federal Fiscal Year (FFY, running from 10/1 to 9/30) have previously
faced challenges. They can now align their SSI ratios with their own
fiscal year using patient detail data (from MedPAR).
- 3. How Non-9/30 Hospitals Can Benefit:
- Hospitals with fiscal year ends that do not align
with the federal fiscal year end (09/30) have the option to use patient
level data from MedPAR. By doing so, only eligible days for the
hospital fiscal year end will be included in the SSI calculation and
realign with the hospital fiscal year end date.
- This alignment process can potentially yield a more favorable SSI ratio, thus increasing DSH reimbursements.
- 4. Risks and Considerations:
- Although the realignment can lead to higher
reimbursements, there's a risk that the recalculated SSI ratio could be
lower than the original one. If this happens, the hospital would have
to repay CMS the difference.
- Hospitals should carefully evaluate the impact of
realignment before requesting a reopening to ensure that the potential
benefit outweighs the risk.
What Hospitals Should Do Now:
SRG
offers specialized expertise in optimizing SSI ratios. SRG can provide
estimates of the potential impact on DSH reimbursements from
realignment, allowing hospitals to make more informed decisions.
Contact us for more information!
Worksheet S-10
Comprehensive Compliance Review
Worksheet S-10 revenue is a critical part of the revenue stream for
hospitals that treat indigent patients through the Medicare
Disproportionate Share Hospital (DSH) program.
The complexity of Worksheet S-10 reporting can be daunting as accurate
records are central to reimbursement that could mean millions of
dollars for your hospital.
To obtain the proper provider
reimbursement you’re entitled, it’s crucial for hospitals to correctly
file Medicare cost report Worksheet S-10.
SRG is ready to work with hospitals to help ensure your
submissions meet the requirements of Worksheet S-10 instructions and in
accordance with your hospital’s charity or financial assistance
policies. Our knowledgeable consultants can be of significant value to
your hospital, particularly with supporting you through audit.
SRG is an industry expert in S-10 preparation, reviews and audits,
having done so for many hospitals across the country.
Contact us today for assistance preparing your S-10 Worksheet,
reviewing the work you’ve done on your S-10 or navigating an S-10
Worksheet audit.
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