4 Burst results for "Jimmy Mendez"

"jimmy mendez" Discussed on The Hospital Finance Podcast

The Hospital Finance Podcast

08:28 min | 6 months ago

"jimmy mendez" Discussed on The Hospital Finance Podcast

"Welcome to the hospital finance podcast. You're go to source for information and insights. They can help you. Stay ahead of the challenges. Impacting healthcare finance and now the host of the hospital finance podcast michael pass. Hi this is mike. Pass not walk back to the award. Winning hospital podcast teaching hospitals very unique set of costs related to preparing future clinicians the medicare program accounts for these costs and provides additional reimbursement to these institutions. However careful reporting around residents and interns is key to receiving the appropriate reimbursement to talk with us about the pitfalls associated with this. I'm joined by jimmy. Mendez senior reimbursement manager here. Bessler jimmy welcome back to the show. Jimmy wants to start us off by telling us what. What is i m e and g me and what type of hospitals do these items pertain to. My fist pertains to the group of hospitals considered teaching hospitals teaching hospitals train. Our future healthcare professionals and are typically at the forefront of medical research and survey vital role in delivering patient care regarding medicare reimbursement. Dj emmy or direct graduate medical education pertains to the direct cost of credited teaching programs. The direct costs include the salaries and fringe benefits of the residents and teaching physicians and other direct costs indirect medical education or i m e relates to the higher patient costs for hospitals due to the presence of these teaching programs and jimmy are payments to hospitals determined well payments to the hospital From the medicare program are producer. Jimmy is determined by multiplying resident. Fte's derived from allowable resident locations subject to a cap times per resident amount or pr a ultimately applied to the medicare party and medicare parts the utilization percentages which of course is representative of their patient. Load the pra if it costs per resident in a base year updated for inflation annually. Pariah me the reimbursement factors involved are the mstar payments received by the hospital. The resident fte counts the hospital's bed count and a multiplier that is provided by cms. Is there a vital. Common factor that impacts both me and digi me and what pitfalls might a hospital encounter well the factor that impacts both are the resident. Fte counts therefore not counting. The resident will patients correctly that comprise. The ftc's can be a major pitfall. There are some differences in the regulations of what rotations can be counted between the two in general rotations. That take place at the hospital related to patient care or die. Tactics can be counted for both. Dj amee an ivy however rotations related to research. That take place at the hospital can be counted for dj. Ame but not trying. In addition when a hospital encourage the salaries and benefit costs of the residents rotations and occur at a non hospital side such as a private physician office for example are allowable for both the me and i mean if the not hospital sites primary function is that of delivering patient. Care however offside time spent in didactics can be counted for. Dj emmy but not. I mean offsite rotations. That take place at another hospital cannot be counted for either. Digi me your ibm. Incidentally i mentioned the word back to the time spent by residents in journal clubs seminars. Classroom lectures and scholar percents. Are there any other issues that result in treating resident rotations differently. For digi me and i may. Yes there is there are certain. Fte counts. That must be waited. A fifty percent for dj me. That did not require waiting. Crime scene the initial residency program. That resident trained in and the affiliated years for that initial initial residency program dictates the maximum of training years that will reimburse at a full. Fte for that resident if the resident exceeds the number of training years affiliated with the years for their initial residency program. The f. t. is at fifty percent for jimmy for dj among there is no waiting implemented for and jimmy. I understand that. Cms places a cap on the resident fte caps. What can you tell me about those and common pitfalls associated with them. Well in general. The cap is determined by the number of allopathic osteopathic empty residents that the hospital trained in its most recent coffee reporting period ending on or before december thirty first nineteen ninety six. The cap does not apply to dental empathize tree over the years. Cms has redistributed fte caps between providers under the medicare modernization. Act and later under the affordable. Care act knowing the history of your caps and historical adjustments to them is imperative for accurate. Costly what are ways to modify the cap subsequent to the initial basir cap being established. Well first of all if the one thousand nine hundred eighty six base near cap has not been established. A hospital can establish a new program and create a cap established in the fifth year of the new teaching program. There are ways to modify the cap on a temporary basis as well. This includes the implementation. An affiliation agreement in which hospitals implement a sharing arrangement between them for the caps the aggregate number of capacities must remain unchanged if facility can also taken displaced residents from a closed program under certain circumstances in have their caps increase as a result depending on the method employees. These could be temporary or permanent adjustments to the cat. Another method to receive jimmy payments for additional slots is for and rural hospitals or rural non-hostile sides to enter into partnerships to form rural training programs. Or rtt's if an if an urban hospital rotates his is dependent in an accredited rtt with a rural hospital. And those rather than spend more than half of their time training at rural hospital the urban hospital may be reimbursed for these residents above its traditional f. are there any other caps that one should be concerned with or there any related common errors that hospitals make regarding the caps. Yes prime me. Prior years residents bed racial serves of a cap to the current years bit racial the residents of bet ratio is simply a calculation of resident. Fte's to the number of beds in news during the year. The prior year resident of racial is an input field on the current year coffee port. A common error is at the cost of poor prepare when calculating the prior year resident tibet. Racial from the prior costs report divides length fourteen by the bed. Count rather than line twelve by the bit com lane. Fourteen is the rolling average equity and line twelve the current year at t.

jimmy Jimmy michael pass Bessler mike fifty percent fifth year both two one thousand nine hundred eigh Mendez december thirty first nineteen Fourteen fourteen Care act Dj emmy emmy first than half hospital finance
"jimmy mendez" Discussed on The Hospital Finance Podcast

The Hospital Finance Podcast

04:13 min | 10 months ago

"jimmy mendez" Discussed on The Hospital Finance Podcast

"Hi this mike. Not and welcome back to the award. Winning hospital finance podcast. The final rule for twenty twenty one has published and to review some highlights of that new rule. I'm joined by jimmy mendez. Who's a senior manager on our reimbursement team here at basler. Jimmy welcome back to the show. Thank you mike. It's good to be here. So jimmy we're going to go through just a few of the items that appeared in this role Let's start off. What can we expect. Regarding the ups payment rate and the asc payment rate increase will be two point. Four percent for the pbs pain. Rate based on this update. Cms estimates the total payments to keep ps providers for calendar year. Twenty twenty one will be approximately eighty four billion dollars which represents an increase of seven and a half billion from the previous year the statutory two percent reduction in payments for hospitals that failed to meet the hospital. Outpatient quality reporting requirements will continue now. Cms adopted policy to date the afc payments system using the hospital market basket. Update the afc payment rate. Update will also be two point. Four percent of the result for hospitals that meet applicable quality reporting requirements. Cms feels this will help to promote citing neutrality between hospitals and cheese and encourage the migration of services from the hospital setting to the lower cost asc setting total payments to afc's are projected to be five point four billion which is an increase of twenty million last year and jimmy every year. Seems like three forty be program is a hot button issue. Are there any changes regarding that program. This year well. My casinos section three forty of the public health service act allows participating hospitals and other providers to purchase certain covered outpatient drugs for manufacturers at discount prices in the previous years. Cms was paying the average sales price or asp minus twenty two and a half percent. The initially proposed to change that to asap minus twenty eight point seven percent but in the end they decided to keep it at esp minus twenty two and a half percent ems believes that maintaining the current payment policy is appropriate in order to maintain consistent and reliable payment during this public health. Emergency we are in the three forty be payment policy continues to exempt rural sole community hospitals children's hospitals and pbs exempt cancer hospitals. Who will continue to be paid at a p plus six percents hospitals have challenged. Cms in court. In efforts to reduce the payment reduction but have been unsuccessful. Okay and let's talk a little bit about the inpatient only list. Can you describe that forest and explain what the plans are for that. Sure the inpatient only lives is a series of seventeen hundred procedures for which medicare will only pay when performed in the hostile impatient setting however cms raised concerns that this list has restricted patient. Choice when it comes to surgery and recently proposed to phase out the list altogether the faith period will take three years and will commence on january first twenty twenty one beginning around three hundred primarily musculoskeletal related services. Okay and were there any notable changes regarding coverage of asc procedures. Well there used to be a theme of facilitating the shifting the procedures from an inpatient setting to an afc setting..

afc jimmy mendez mike basler jimmy Cms asc pbs Jimmy cancer medicare
"jimmy mendez" Discussed on The Hospital Finance Podcast

The Hospital Finance Podcast

07:25 min | 1 year ago

"jimmy mendez" Discussed on The Hospital Finance Podcast

"I this is my best day and welcome back to the award-winning hospital finance podcast. As we do every year bessler releases a summary of the final rule and to give us some highlights of this year's rule. I'm joined by Jimmy Mendez, who is a senior manager on our reimbursement services team here at Basler Jimmy Welcome back to the show. Here. Jimmy the release of the PS final rule for twenty twenty one was delayed several weeks due to covert nineteen this year. What were some of the most anticipated pieces of information? Well as usual, some of the key areas are the mass market basket rate, increase the uncompensated care figures, and of course, a wage index related information. Now you bad. So let's walk through those what happened to the market basket rate. The market basket rate increase will be two point four percent for fiscal year two, thousand, twenty, one. This will be the updated providers that submit quality data and our meaningful E. H. R. Users. This figure is reduced by point six percent it quality data is not submitted and reduced an additional one point eight percent if the provider is not a meaningful E. H. R. User. Jimmy what did the figures for? CARE look like. The bow to be distributed in uncompensated care for F.. Y. Twenty twenty one is eight, point, two nine. This is just slightly down from the eight point, three, five, billion distributed in F-, wide, twenty twenty. However, the proposed at twenty twenty, one amount had been seven, point, eight, one, seven, billion. Factor. To the calculation is the uninsured estimate provided by CMS, his office of the actuary that estimate was sixty seven point eighty, six percent in the proposed final, but it was adjusted to seventy seventy, two, point eighty, six percent in the final rule, the updated figured takes into consideration the effects of covid nineteen, and of course, this contributed to the amount in the final rule being eight, point, two, nine billion and that being higher than what was proposed initially. For factor three B uncompensated care calculation cms will use line thirty from the two thousand seventeen cost report as two thousand seventeen is the most recently available single year with audited S. ten data. For future years, CMS will. To use the most recent available single year audited as and that. Were there any interesting developments for wage index? Well. There was some movement in the designations of numerous counties. There are thirty four counties designated as urban that will now be rural forty seven counties that were previously rural that will now be urban and nineteen counties will move to another CBS say or to a new or modified CBS eight. But one was keep in mind that there is a five percent cap on any decrease in a hospitals wage index from the hospitals final wage index in fiscal year twenty twenty. In addition approximately two, hundred, eighty, five hospitals will benefit from the rural floor rule being applied. These are urban area hospitals of the State whose wage index is below the area wage into applicable to hospitals located in rural areas of that state. Wage, index will be set at the rural area level. So, when you think about the whole roll Jimmy, what are some areas of concern? Well an important one relates to Medicare. Bad debts. Forty to see a far or one three, eighty nine discloses the requirements for Medicare bad debt as does the provider Reimbursement manual or PRM chapter three the Pr Am is more detail and is what hospitals are accustomed to comply with based on its application by the respective. Max The purpose of the final rule appears to code by the PRN chapter three requirements, most of which will apply retroactively. There are a couple of requirements that I wished to essentially. One pertains to the process of determining that a non dual eligible beneficiary is indigent and thus exempt from the reasonable collection effort requirements. The rule stipulates the provider must not use a beneficiaries declaration of their inability to pay their medical bills or deductibles incur insurance as sole proof indigenes for medical kits. The provider must take into account the analysis, the both of beneficiary facets, only those convertible to cash, and then necessary for the beneficiaries daily living and income. and must determine that no source of the beneficiary would be legally responsible for the beneficiaries medical bill such as the legal. Guardian or State Medicaid Program. Another pertains to how bad debts reported on the financial statements for cost reporting periods beginning on or after October first twenty twenty Medicare, at the that's. Not Be written off to contractual allowance account, but must be charged to an uncollectible receivables account the results in a reduction in revenue. Were there. Any other issues that caught tension? Well. Mike There are twelve new MSTAR jeez including MS DART eighteen kyw merrick Antigen Receptor T. cell immunotherapy. which has the biggest the RG weight of thirty seven point thirty, three surpassing the DR weight of Ms. A zero one heart transplant. Two of the new embassy are Jeez. Five Twenty One and five, twenty, two relate to hip replacement and are subject to the post acute transfer policy. Other items of note, include the back that stem cell acquisition costs will be reimbursed on a reasonable cost basis effective precaut- reporting periods beginning on or after ten, one, hundred, twenty. Hospitals are not required to be Medicare certified transplant centers like solid organ transplant centers are required to be the determination of Medicare share of the stem cell acquisition costs will be somewhat different than that. Employ solid organs that the mechanics of how it will work or not entirely clear yet. Also a new requirement relates to market based Ms. The RG data collection and change in methodology for calculating the relative rates. Hospitals will be required to report on their Medicare caution for the median pair specific negotiated. At the hospital has the dossier with all of its Medicare advantage organization pairs by DAS BY MS. For cost reporting periods ending on or after January. First Twenty,.

Jimmy Mendez Medicare twenty twenty Y. Twenty Basler Jimmy E. H. CBS senior manager Mike There State Medicaid Program Ms. The
"jimmy mendez" Discussed on The Hospital Finance Podcast

The Hospital Finance Podcast

02:34 min | 1 year ago

"jimmy mendez" Discussed on The Hospital Finance Podcast

"Welcome to the hospital finance podcast you're go to source for information and insights that can help you stay ahead of the challenges impacting healthcare finance, and now the host of the hospital finance podcast. Michael, pass not say. I might not and welcome back the wording hospital finance podcast. WORKSHEET has ten has become an increasingly important part of uncompensated care reimbursement to help us understand more about worksheet has ten. I'm joined by Jimmy Mendez who is a senior manager on our reimbursement services team at bessler Jimmy Welcome back to the show. Thank you Mike? Jimmy why don't you start out by explaining why? Worksheet S. ten on the Medicare cost report has become so important. Well Mike work ten is critical to any facility that treats a high number of dish patients. Any facility that has a patient percentage over fifteen percent is entitled to a portion of the uncompensated care pool. This uncompensated care pool is a set of now for fiscal year two thousand twenty that cms allocates to all eligible hospitals. The allocation percentage for each each hospital is directly linked to the uncompensated care. Total reports on Worksheet S. ten. Jimmy Water, some of the key data files that are needed to get started with the preparation of worksheet has ten. These include the following eight thirty five warns a thirty-seven forums age trial balance detailed. Charges General Ledger and financial statements. Insurance Master. Transaction Code Master. Hospital service mapped by patient type. Bad Policies. Charity Policy. Financial assistance policies. Patient demographics. Charge detail. which ones are the most critical Jimmy? Most critical are the transactions which is the in accounting transaction, detail, the charge detail and the patient demographics. Let's start with the patient accounting transaction detail. Essentially you want a complete download of the patient accounting system. This will allow you to identify. All of the transactions applied to patients account.