tci Medicare Compliance & Reimbursement - 2004 Issue 25

HOSPITALS - Medicare Fractions 101: Let CMS Do Your DSH Math

What hospitals do -- and don't -- have to worry about with the complex DSH pay formula. Calculating disproportionate share hospital pay doesn't need to feel like brain surgery. When working out Medicare and Medicaid fractions for patients with dual eligibility, the word from the HHS Office of Inspector General is that hospitals should never include Medicare Part Apaid days in the Medicaid fraction of their DSH calculations. An audit report released May 21 titled "Review of Medicare Disproportionate Share Hospital Payments Claimed By Saint Mary's Regional Medical Center for Fiscal Year Ending December 31, 2002" (A-01-04-00506) found that...

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