The Medicare Disproportionate Share Payments remain one of the few areas in Prospective Payment Reimbursement where a detailed concentration of review can benefit the hospital through a direct increase in cost report settlement. While under reporting days may cost some reimbursement, a larger issue is the over reporting of days. The intermediary's audit guidelines call for an extrapolation of any error. This means that a $1 error can easily cost you $10. This makes it imperative that you not only claim what you are due, but also not claim anything that you are not eligible for. Our services for Disproportionate Share reimbursement encompass 'scrubbing' the hospital's inpatient claims' data  to ensure that all eligible days are properly claimed and documented for audit.  We will perform the following steps:

  • Verify Medicaid eligible days
  • Verify out of State eligible days
  • Insure that eligible days relate to PPS services
  • Insure that Observation days are appropriately accounted for
  • Review of the Supplemental Security Index (SSI) ratio
  • Determine the advantage or disadvantage of a re-calculation of the SSI ratio on the basis of a non-governmental fiscal year-end
  • Determine DSH opportunity for rehabilitation units (IRF)
  • Use the above steps to appropriately document and claim Rehab DSH which is called low-income patient payment or LIP
  • Provide support through the audit process with your fiscal intermediary

Fiscal Intermediaries continue to place more stringent audit guidelines on the detailed review of the disproportionate share payment calculations and likewise, hospitals should continue to place a greater emphasis on ensuring accuracy in reporting in this area to receive a complete and accurate amount of payments allowed under Medicare regulations.