Corporate Compliance

Gov’t audit insider: Medicare disproportionate share payments

Healthcare Auditing Weekly, November 25, 2003

The OIG's objective for this review was to determine whether the hospital's fiscal year (FY) 1999 claim for Medicare disproportionate share hospital (DSH) reimbursement complied with Medicare reimbursement criteria. The OIG performed the following steps for this review:

1. Met with staff from the hospital's fiscal intermediary (FI) to discuss the FI's role in the Medicare cost report settlement process.

2. Reviewed Medicare cost reports, settlement information, audit work papers, and permanent files pertaining to the Medicare DSH reimbursement claimed for the period January 1, 1999 through December 31, 1999.

3. Met with hospital staff to review the procedures used in preparing the list of Medicaid eligible days and calculating the supplemental security income (SSI) ratio used in calculating $21,217,380 in Medicare DSH adjustments and the $842,588 Medicare capital DSH component of Medicare capital.

4. Reconciled the FY 1999 SSI ratio to the FY 1999 CMS published amount.

5. Reconciled the Medicaid eligible day count used in the Medicare DSH calculation to a summary detail of state Medicaid eligible days provided by the hospital.

6. Reviewed and tested supporting documentation for the eligible days pertaining to each state. To do this, the OIG used the summary detail of state Medicaid eligible days included in FY 1999 Medicaid history and claim data.

Click here to read the audit report "Review of Medicare Disproportionate Share Hospital Payments for Methodist Hospital - Memphis for Fiscal Year 1999."

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