April 19, 20231

Welcome to the Jurisdiction 11 (J11)

Part A World!

April 19, 2023

Audit and Reimbursement (AR)

NGS AR Activities: Wage Index Desk Review-Audits Settlements

Lead of the Process Reopening

Primary Reviewer

Palmetto GBA AR Activities: Reimbursement Cost Report Receipt Settlements

Issue the Settlement Reopening

Filed Directly to Palmetto GBA

Cost Report Appeals Payments

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April 19, 2023

Occupational Mix Survey

FY 2010-2012 wage index based on 2007-2008 Survey

FY 2013-wage based on 2010 survey

CY 2010 Occupational Mix Survey

Published in the January 15, 2010 Federal Register

Due to MAC no later than July 1, 2011

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April 19, 2023

Wage Index – Pension Expense

CMS instructions dated November 9, 2011

Guidance for determining defined pension Plan cost for FY 2013 wage index

Different treatment for wage index and cost finding

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April 19, 2023

Pension Expense

ERISA rules changed, not standard actuarial basis or limit for pension costs

Previous Medicare treatment: Allow pension contributions must be paid within one year to liquidate liability

New Medicare treatment: Allow cash contributions

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April 19, 2023

Wage Index – Pension Expense

Effective beginning FY 2013 wage index calculation

Use actual pension contributions funded during the reporting period on a cash basis

Trending Use average of cash contributions for three years

Transition policy for “prefunded” pension plans 10 year transition for cash contributions made in excess of wage index

amounts for periods beginning on or after 10/01/2002 and prior to 10/01/2008

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April 19, 2023

FY 2012 IPPS Final Rule

Effective for cost report periods beginning on or after October 1, 2011

Actual contributions to pension plan allowed on cash basis

No longer a one year period to liquate the liability

150 percent limit on contributions 150 % of three consecutive Medicare cost report periods out of five

most recent cost report periods with the highest average If contributions are in excess of limit, hospital must demonstrate

costs are reasonable and necessary7

April 19, 2023

Electronic Format

Transition to paperless environment More efficient for providers and MAC Electronic workpapers More secure Encryption required for (PHI, PII)

Correspondence and NPRs sent through email Need to ensure A & R email contacts are current

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April 19, 2023

Miscellaneous

DSH Eligibility Medicaid eligibility must be confirmed by the

state agency

Status of NPRs on hold PS&R SSI data

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April 19, 2023

Questions

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