Hospice Medicare Cost Report Changes: Get a Proper Start

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1 Nvember 12, :00 11:30 AM Central Time Hspice Medicare Cst Reprt Changes: Get a Prper Start Mark P. Sharp, CPA Partner BKD, LLP T Receive CPE Credit Participate in entire webinar Answer plls when they are prvided If yu are viewing this webinar in a grup Cmplete grup attendance frm with Title & date f live webinar Yur cmpany name Yur printed name, signature & address All grup attendance sheets must be submitted t within 24 hurs f live webinar Answer plls when they are prvided If all eligibility requirements are met, each participant will be ed their CPE certificates within 15 business days f live webinar 2 // experience access 1

2 Objectives Identify upcming changes in hspice Medicare cst reprt Discuss changes needed t hspice chart f accunts Initiate needed adjustments in hspice internal recrd tracking fr accurate & cmplete reprting Discuss anticipated uses f new hspice cst reprt infrmatin nce submitted t CMS 3 // experience access New Hspice Cst Reprt Outlined in CMS Transmittal in August 2014 Little change frm Nvember 2013 prpsed changes Guidance/Guidance/Transmittals/2014-Transmittals- Items/R1P243.html 4 // experience access 2

3 New Hspice Cst Reprt Effective fr cst reprting perids beginning n r after Octber 1, 2014 Freestanding prviders nly fr nw Prvider-based delayed 5 // experience access New Hspice Cst Reprt Items unchanged Fr reprting all csts Csts adjusted based n Medicare requirements Use f general cst centers t be allcated t prgram cst centers Utilizatin data relatively same Cmputes csts per day Csts attributed t payer 6 // experience access 3

4 New Hspice Cst Reprt Changes designed t cmpute csts by level f care Cntinuus hme care Rutine hme care Inpatient respite care General inpatient care 7 // experience access New Hspice Cst Reprt Increased allcatins fr general service csts Often referred t as verhead items Expanded frm 6 t 16 general cst centers Mre methds fr allcatins Smewhat cmparable t hspital cst reprts 8 // experience access 4

5 General Service Cst Centers Capital building & fixtures Capital mveable equipment Emplyee benefits Administrative & general Plant peratins & maintenance Laundry & linen service Husekeeping Dietary Nursing administratin Rutine medical supplies Medical recrds Staff transprtatin Vlunteer service crdinatin Pharmacy Physician administrative services Other general services 9 // experience access Hspice Patient Care Cst Centers Inpatient care - cntracted Medical scial services Lab & diagnstics Physician services Spiritual cunseling Nnrutine medical supplies Nurse practitiner Dietary cunseling Outpatient services Registered nurse Cunseling - ther Palliative radiatin therapy LPN/LVN Aide & hmemaker Palliative chemtherapy Physical therapy DME/xygen Other patient care Occupatinal therapy Patient transprtatin Speech therapy Imaging services 10 // experience access 5

6 Nnreimbursable Cst Centers Bereavement prgram Vlunteer prgram Fundraising Hspice/palliative med fellws Palliative care prgram Other physician services Residential care Advertising Telehealth/telemnitring Thrift stre Nursing facility rm & bard Other nnreimbursable 11 // experience access Tur f New Cst Reprt Frms 12 // experience access 6

7 Cst Reprt Purpse Believe it r nt, it matters Justify Medicare rates Used fr payment system refinements Ptential rate rebasing Prvides invaluable management infrmatin It is the law! 13 // experience access Surces f Data Accunting infrmatin Trial balance Sufficient chart f accunts Financial statements General ledger Payrll data Break dwn by level f care 14 // experience access 7

8 Surces f Data Utilizatin & charge data Internal billing & clinical sftware Cntractrs/service prviders, i.e., PBM, DME/xygen, etc. PS&R frm IACS r MAC Office/facility flr plans Other allcatin statistics? 15 // experience access Making Necessary Changes Time & mney investment Revising chart f accunts Adjusting data cllectin methds Payrll Charges & utilizatin Statistics Reviewing agency prcesses Prviding staff training 16 // experience access 8

9 Chart f Accunts Key t successful transitin Sufficient detail fr yur needs S yu dn t have t backtrack Fr cst reprt purpses Fr management purpses See full example in Attachment B 17 // experience access Chart f Accunts Keep revenue & csts in right buckets Revenues by service & payer Csts by type f csts per cst reprting & management needs General service Direct patient care services Nnreimbursable services Unallwable csts Match cst buckets with revenue buckets 18 // experience access 9

10 Chart f Accunts General Service Csts Capital building & fixtures Nursing administratin Capital mveable equipment Rutine medical supplies Emplyee benefits Medical recrds Administrative & general Staff transprtatin Plant peratins & maintenance Vlunteer service crdinatin Laundry & linen service Pharmacy Husekeeping Physician administrative services Dietary Other general services 19 // experience access Chart f Accunts Reimbursable Direct Patient Care Service Csts Inpatient care - cntracted Medical scial services Lab & diagnstics Physician services Spiritual cunseling Nnrutine medical supplies Nurse practitiner Dietary cunseling Outpatient services Registered nurse Cunseling - ther Palliative radiatin therapy LPN/LVN Aide & hmemaker Palliative chemtherapy Physical therapy DME/xygen Other patient care Occupatinal therapy Patient transprtatin Speech therapy Imaging services 20 // experience access 10

11 Chart f Accunts Reimbursable direct patient care services Brken dwn by level f care Sample accunts fr registered nurse wages 21 // experience access Chart f Accunts Sample f tracking wages & travel by level f care (ldfashined way) 22 // experience access 11

12 Chart f Accunts Tracking ther reimbursable direct patient care services by level f care DME/xygen Patient transprtatin Imaging services Labs & diagnstics Nnrutine medical supplies Other patient care csts 23 // experience access Chart f Accunts Nnreimbursable Service Csts Bereavement prgram Vlunteer prgram Fundraising Hspice/palliative med fellws Palliative care prgram Other physician services Residential care Advertising Telehealth/telemnitring Thrift stre Nursing facility rm & bard Other nnreimbursable 24 // experience access 12

13 Chart f Accunts Nnreimbursable versus unallwable Nnreimbursable receives allcatin frm general service csts Unallwable csts remved & d nt receive allcatin frm general service csts Be sure chart f accunts maintains detail t easily identify unallwable csts t 25 // experience access Utilizatin Data Hspice days by level f care by Medicare, Medicaid & Other Dual eligibles g int Medicare Cntracted days fr inpatient respite care & general inpatient care by Medicare, Medicaid & Other Subset f ttal hspice days 26 // experience access 13

14 Statistics T allcate general service csts Capital building & fixtures Square ftage Capital mveable equipment Dllar value (net bk value f equipment) Cnsider requesting square ftage Emplyee benefits Grss salaries 27 // experience access Statistics T allcate general service csts Administrative & general Accumulated csts Plant peratins & maintenance & husekeeping Square ftage Cnsider request fr change in rder f allcatin t preadministrative & general allcatin 28 // experience access 14

15 Statistics T allcate general service csts Laundry & linen, dietary & residential care services In-facility days (nn-cntracted) Nursing administratin Direct nursing hurs 29 // experience access Statistics T allcate general service csts Rutine medical supplies, medical recrds & physician administrative services Patient days Staff transprtatin Mileage Generally when fleet utilized 30 // experience access 15

16 Statistics T allcate general service csts Vlunteer service crdinatin Hurs f service Cnsider request fr change in rder f allcatin (pre-a&g) Activity Administrative & general Patient residence patient supprt Fundraising Marketing/advertising Etc. Hurs 31 // experience access Statistics T allcate general service csts Pharmacy Charges Fur levels f care plus nnreimbursable services & unrelated t terminal illness Per diem can use cntract rates by type f day Cnsider requesting patient days 32 // experience access 16

17 Use f Cst Reprt Data Key perfrmance indicatrs Current cst reprt prvides gd infrmatin See Attachment C fr example New cst reprt inf will be better Medicare rate changes & payment mdel refrm Embrace the changes! 33 // experience access Questins? 17

18 Thank Yu! Mark Sharp Cntinuing Prfessinal Educatin (CPE) Credits BKD, LLP is registered with the Natinal Assciatin f State Bards f Accuntancy (NASBA) as a spnsr f cntinuing prfessinal educatin n the Natinal Registry f CPE Spnsrs. State bards f accuntancy have final authrity n the acceptance f individual curses fr CPE credit. Cmplaints regarding registered spnsrs may be submitted t the Natinal Registry f CPE Spnsrs thrugh its website: The infrmatin in BKD webinars is presented by BKD prfessinals, but applying specific infrmatin t yur situatin requires careful cnsideratin f facts & circumstances. Cnsult yur BKD advisr befre acting n any matters cvered in these webinars. 36 // experience access 18

19 CPE Credit CPE credit will be awarded upn verificatin f participant attendance Fr questins, cncerns r cmments regarding CPE credit, please the BKD Learning & Develpment Department at 37 // experience access 19

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