E/M Coding Alert - 2004 Issue 25
HOSPITALS - Medicare Fractions 101: Let CMS Do Your DSH Math
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Article Overview
This piece covers Medicare disproportionate share hospital (DSH) payment calculations, with emphasis on how Medicare and Medicaid patient-day fractions are handled in cost reporting. It is aimed at hospital billing, reimbursement, and compliance staff who need a general understanding of DSH math, dual-eligibility considerations, and the role of CMS and OIG guidance in reviewing reported patient days.
Why This Topic Matters
DSH calculations affect hospital reimbursement and cost report accuracy, so understanding which portion of the math is handled by CMS and which portion is the hospital’s responsibility helps support compliant reporting and avoids payment adjustments.
What You Will Learn
- The general structure of Medicare DSH payment calculations
- How Medicare and Medicaid patient-day fractions are described in DSH reporting
- The respective roles of hospitals and CMS in DSH fraction determination
- Why dual-eligibility and patient-day classification matter in DSH calculations
- How an OIG audit report relates to hospital cost report review
Who Should Read This
- Hospital billing staff
- Hospital reimbursement specialists
- Healthcare compliance professionals
- Revenue cycle teams
- Medicare cost report preparers
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