By we are describing patient accounts with dates of service prior to an open cost “old” reporting period, logs and the corresponding Medicaid Cost Report Schedule F. While a closed Medicaid Cost Report cannot be edited to include additional uninsured charges or payments, these charges and payments can be included with the Schedule F patient level data submitted to the federal auditors for that Cost Report year, and will be reflected in the DSH audit results. Once that DSH audit is completed, that fiscal year is hospital’s considered closed and final. 8.3 If a patient was on Disability Assistance on the date of service, but later was retroactively made eligible for Medicaid after the Medicaid Cost Report for that hospital’s period was filed, can the hospital bill the account to Medicaid? Yes. 8.4 How would a hospital log the recovery of a bad debt? All payments received on any account reported as uninsured in any reporting period must be included in the Cost Report that covers the date the recovery or payment was received. 8.4a How should a hospital report a lump sum, bad debt recovery that cannot be tracked back to individual patient accounts? All payments should be included in the Cost Report that covers the date the payment was received. If a lump sum recovery covers both accounts that were claimed as uninsured and accounts that were not claimed as uninsured, a prorated portion of the recovery that corresponds to the charges claimed as uninsured should be reported. 8.5a When is a patient to be considered “with insurance?” A patient is considered to be only when the service is within a covered “with insurance” benefit package in a group health plan or other health insurance coverage, and is not covered by another legally liable third party. 8.5b Would a self-pay deductible or coinsurance amount be logged as with or without insurance? While a deductible or co-insurance amount is the responsibility, (s)he is patient’s nonetheless insured for so the entry and amount would be logged as “with insurance.” 8.5c Are self-pay charges for a managed–care patient who has had services out of network considered to be with or without insurance? Assuming the patient is not eligible for Medicaid (see FAQs 2.9 & 2.10) any covered self-pay charges for a managed care patient who went out of network would be considered “with insurance.”
By “old” we are describing patient accounts with dates of service prior to an open cost reporting period, logs and the corresponding Medicaid Cost Report Schedule F. While a closed Medicaid Cost Report cannot be edited to include additional uninsured charges or payments, these charges and payments can be included with the Schedule F patient level data submitted to the federal auditors for that Cost Report year, and will be reflected in the hospital’s DSH audit results. Once that DSH audit is completed, that fiscal year is considered closed and final. 8.3 If a patient was on Disability Assistance on the date of service, but later was retroactively made eligible for Medicaid after the hospital’s Medicaid Cost Report for that period was filed, can the hospital bill the account to Medicaid? Yes. 8.4 How would a hospital log the recovery of a bad debt? All payments received on any account reported as uninsured in any reporting period must be included in the Cost Report that covers the date the recovery or payment was received. 8.4a How should a hospital report a lump sum, bad debt recovery that cannot be tracked back to individual patient accounts? All payments should be included in the Cost Report that covers the date the payment was received. If a lump sum recovery covers both accounts that were claimed as uninsured and accounts that were not claimed as uninsured, a prorated portion of the recovery that corresponds to the charges claimed as uninsured should be reported. 8.5a When is a patient to be considered “with insurance?” A patient is considered to be “with insurance” only when the service is within a covered benefit package in a group health plan or other health insurance coverage, and is not covered by another legally liable third party. 8.5b Would a self-pay deductible or coinsurance amount be logged as with or without insurance? While a deductible or co-insurance amount is the patient’s responsibility, (s)he is nonetheless insured for so the entry and amount would be logged as “with insurance.” 8.5c Are self-pay charges for a managed–care patient who has had services out of network considered to be with or without insurance? Assuming the patient is not eligible for Medicaid (see FAQs 2.9 & 2.10) any covered self-pay charges for a managed care patient who went out of network would be considered “with insurance.”
HCAP-July-2016-FAQ-Updates.docx