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.

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.

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.