Description

Medicare Cost Reports are the annual reports submitted by a healthcare organization to the Healthcare Cost Report Information System (HCRIS) containing provider information such as facility characteristics, utilization data, cost and charges by cost center. The session will discuss the interface between the hospitals’ chargemaster and the Medicare Cost Report, along with the factors which affect the proper development of the report.

The organization of chargemaster and the setting charges affect the development of the Medicare cost report. There are many instances where cost-to-charge (CCR) ratios have adversely impacted the hospitals’ reimbursement programs such as APC and DRG. The cost-to-charge ratio shows the relationship between a hospital’s expenses and what they charge. The session will include the critical issues faced while developing the Medicare cost report as well as the effects of cost-to-charge ratios on the report.

Medicare program is changing and updating the cost reporting process in some areas for the accurate reporting of charges. The session will also include the strategies which the chargemaster coordinators need to use for interaction with the cost reporting personnel to comply in the area of finance.

Objectives:-

• To review how APCs and DRGs use the Charges from Filed Claims.
• To appreciate how the Cost Report is prepared.
• To review recent changes in the Cost Reporting Process.
• To understand The All-Important Cost-to-Charge Ratios (CCRs).
• To review Revenue Codes and its impacts on CCRs.
• To acknowledge the issues surrounding implantable medical devices.
• To recognize how chargemaster pricing structure can influence the cost report.
• To appreciate the Medicare charging rule and its impact on both the chargemaster and cost reporting process.
• To review action steps that chargemaster coordinators can take to improve the cost reporting interface to the chargemaster.
• To review special situations in which reimbursement for hospitals is directly influenced by the Cost Report.
• To address special situations such as Provider-Based Clinics and Special Medicare Payment Processes.

Outline/Agenda:- 

• The session will have an overview of cost reporting process, maintenance of chargemaster, background of APC and DRG, and revenue codes.
• We will review the Medicare Charging Rule – charging limitations and consistency of charges.
• Cost report preparation will also be highlighted, along with the changes, basic financial process, cost-to-charge ratios (CCR) and grossing-up charges.
• There will be a discussion on Chargemaster and Cost Reporting Interface.
• Chargemaster Coordinator Action Steps will be included.
• Special Situations
  • Blood and Blood Products
  • Device Dependent APCs and DRGs
  • Implantable Medical Devices
  • Changes to the Cost Reporting Process
  • Current CMS Proposed Changes Affecting CCRs
  • Provider-Based Clinics
  • Sole Community Hospitals (SCHs)
  • Critical Access Hospitals (CAHs)

Prerequisites for Participating:- 

Understanding of the chargemaster and charge development process will be beneficial.

Who Should Attend?

Chargemaster Coordinators, Billing and Claims Generation Personnel, Compliance Personnel, Patient Financial Management Personnel, Cost Accounting Personnel, Cost Report Personnel, Financial Analysts, Managed Care Contract Personnel, Revenue Enhancement Personnel, Chief Financial Officers, Chief Compliance Officers, Financial Planners, All Other Hospital Personnel Interested in Pricing