al josephs hillcrest health system1 things to look for in monitoring the cost report process...
TRANSCRIPT
Al Josephs Hillcrest Health System
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Things to Look for in Monitoring
the Cost Report Process
HCCA’s 2000 Compliance Institute
September 25, 2000
New Orleans, Louisiana
Al Josephs Hillcrest Health System
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Introduction Compliance issues
related to the external reporting of organizational information often associated with financial reporting Contact information:
254-202-8620
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Samples of External Reporting
Provider Cost Report Reimbursement Questionnaire HCFA-339 (PCCRQ)
Cost Report HCFA 2552 Bond Issue Covenants AHA Annual Survey
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Provider Cost Report Reimbursement Questionnaire HCFA-339 (PCCRQ)
Document required to be submitted with the Cost Report
Purpose:To assist in the preparation of an acceptable cost report and to minimize the need for direct contact between the provider and the intermediary
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PCCRQ HCFA339
Categories of Questions Organization and
Operations Financial Data Insurance Deferred Compensation Educational Activities Non-paid Workers
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PCCRQ HCFA 339 Categories of Questions--
cont’d Purchased services Provider based physicians Bad debts Bed complement Owner/Management
comp. Wage related cost
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PCCRQ HCFA 339
Assignment of Responsibility Human Resources Senior Management Finance/Reimbursement Patient Accounting
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PCCRQ HCFA 339 Prioritize your approach
(based upon identified risk within your organization):1. Provider based physicians2. Purchased services3. Bad debts4. Wage/Compensation
issues
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PCCRQ HCFA 339Provider Based Physicians
Review Plan Identify related questions Compile related rules and
regulations Review all agreements Review related policies and
procedures
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Cost Report HCFA-2552
Document for reporting the cost of health care services provided to Medicare beneficiaries
Purpose:To supply information required to determine annual program reimbursement and provide a data base to aid in the management of Federal programs
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Cost Report HCFA-2552
Representation&
Certification Statement
See Handout
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Cost Report HCFA-2552
Table of Contents100 Depreciation 200 Interest Expense 300 Bad Debts, Charity, and
Courtesy Allowances400 Cost of Educational
Activities 500 Research Costs
600 Grants, Gifts, and
Income From Endowments
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Cost Report HCFA-2552
Table of Contents--cont’d700 Value of Services of Nonpaid
Workers 800 Purchase Discounts and
Allowances and Refunds of Expenses
900 Compensation of Owners 1000 Cost to Related
Organizations
1200 Return on Equity Capital of
Proprietary Providers
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Cost Report HCFA-2552
Table of Contents--cont’d1400 Reasonable Cost of Therapy
and Other Services Furnished by Outside Suppliers
2100 Costs Related to Patient Care
2200 Determination of Cost of Services to Beneficiaries
2300 Adequate Cost Data and
Cost Finding
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Cost Report HCFA-2552
Table of Contents--cont’d2400 Payment to Providers
Limitations on Coverage of Costs Under Medicare and Notice of Schedule of Limits on Provider Costs
2600 Lower of Cost or Charges 2700 ESRD Services and Supplies
2800 Prospective Payments
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Cost Report HCFA-2552
Table of Contents--cont’d 2900 Provider Payment
Determination And Appeals Procedures
3000 NON-PPS Hospitals and
Distinct Part Units
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Cost Report HCFA-2552
Prioritize your approach (based on identified risk within your organization):1. Cost Finding Statistics
Square feetPounds of laundryHours of serviceMeals served
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Cost Report HCFA-2552
Prioritize your approach:--cont’d2. Non-Reimbursable Cost3. Non-Reimbursable Cost
Centers4. Bad Debt, Charity, and
Courtesy Allowance5. Education
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Cost Report HCFA-2552
Bad Debt, Charity, and Courtesy Allowance Review Plan Evaluation of policy and
procedures Review of any FI audit
adjustments Interviews with staff Flow chart of process
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Other External Reporting
Bond Covenants
AHA Annual Survey
IRS Form 990 Tax-exempt organizations
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Conclusion
Responsibility for completion ofthese documents has traditionally been assigned to the
finance/reimbursement functions in most organizations.
The compliance professional will have little to add to the “number
crunching” components of the process.
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ConclusionThe skills of the compliance professional are expected to be focused on the related rules and
regulations, instructions, and the evaluation, testing, and monitoring of the many processes that bring the required information together for use in external reporting.