2021 Institutional Cost Report (ICR)
NYS Department of Health
Division of Finance & Rate Setting
Bureau of Hospital & Clinic Rate Setting
- Presentation is also available in Portable Document Format (PDF)
April 4, 2022
Agenda
- ➣ Software, Support & Filing Procedures
- ➣ 2021 ICR Audit Fees
- ➣ Health Commerce System
- ➣ Department of Health Public Website
- ➣ 2021 ICR Updates
- ➣ Questions
Software, Support & Filing Procedures
- ➣ Obtaining Software and Support
- Software will be available for download from the Health Financial Systems (HFS) website.
Note: The Department will provide hospitals with the URL, Username and Password using the Health Commerce System (HCS).
- Software will be available for download from the Health Financial Systems (HFS) website.
- ICR problem resolution and questions:
- Hospital.ICR@health.ny.gov
Note: please do not send via secure email - DOH security prohibits these emails - Include in subject line: "2021 ICR" - hospital name
- For problem resolution, send your "four-pack" files (CR, IC, B_, T_) to this email address. The files will then be forwarded to HFS, if necessary
- Hospital.ICR@health.ny.gov
- ➣ Electronic Filing Procedures
- DH file (HCS electronic submission - Hospital ICR application):
- Due date: Wednesday, June 1, 2022
- Electronic submission of documents within 5 Business days of electronic DH file submission:
- Signed CFO/CEO certification
- Edit Report (Initialed with explanations)
- Final Audited Financial Statements
- ✤ "Draft" statements cannot be used for audit purposes
- Email files to: AFS@health.ny.gov
Note: please do not send via secure email - DOH security prohibits these emails - Signed CFO/CEO Certification:
- File named with 7 digit operating certificate number and "_CFO"
- Example: 1234567_CFO
- File named with 7 digit operating certificate number and "_CFO"
- Edit Report (initialed with explanations):
- File named with 7 digit operating certificate number and "_Edits"
- Example: 1234567_Edits
- File named with 7 digit operating certificate number and "_Edits"
- Audited Financial Statements:
- File named with 7 digit operating certificate number and "_AFS"
- Example: 1234567_AFS
- File named with 7 digit operating certificate number and "_AFS"
- DH file (HCS electronic submission - Hospital ICR application):
2021 ICR Audit Fees
- ➣ Due at time of filing
- ➣ Same fee schedule as previous years
- ➣ Same payment process as previous years
- ➣ Email notification to be released for facility-specific fees
- ➣ Fee schedule
Health Commerce System (HCS)
- ➣ Website
- ➣ Communication Tool
- Secure network for posting provider information
- Keep email address current
- ✤ Facility´s responsibility
- ✤ Email blast separate from public website electronic mailing list
- ➣ HCS Help Contact
- Commerce Accounts Management Unit (CAMU) Help Desk: 1-866-529-1890 or camu@its.ny.gov
- ✤ HCS accounts
- ✤ Password resets
- ✤ Removal of employee
- Commerce Accounts Management Unit (CAMU) Help Desk: 1-866-529-1890 or camu@its.ny.gov
- ➣ HCS Access Contact
- Hospital Fee-for-Service Rate Unit: HospFFSunit@health.ny.gov
- ✤ Receiving access to the ICR (or other hospital applications)
- ✤ Rate related questions
- Hospital Fee-for-Service Rate Unit: HospFFSunit@health.ny.gov
Department of Health Public Website
- ➣ Information posted for ICR
- ➣ Information posted for Inpatient Rates and Weights
- ➣ Information posted for APG Rates and Weights
- ➣ Electronic Mailing List Subscriptions
2021 ICR Updates
- ➣ Exhibits (changes, additions & clarifications)
- Ambulance Services (FYE on or after 6/30/2021)
- ✤ New line 164.89 - "As of the last day of the ICR period, did the hospital provide ambulance services this report year?"
- ✤ "Providing Ambulance services" - Hospital operates an Ambulance service, not a contracted service and is eligible for non-comparable add-on within the Acute Medicaid rate
- Interest Rate Swaps
- ✤ Interest rate swaps must be adjusted out prior to applying investment income
- Related-Party Interest
- ✤ Instructions updated
- ✤ Related interest-bearing arrangement between one hospital to related hospital/entity
- Interest Expense
- ✤ Line 13, Interest Expense - "Operating" (previously "Working Capital")
- ✓ Updated header to clarify intent with regards to offsetting Investment Income
- ✓ Per Part 86 - Interest on current indebtedness shall be treated and reported as an operating/ administrative expense
- ✤ Line 13, Interest Expense - "Operating" (previously "Working Capital")
- CPEP Observation Beds
- ✤ Effective 4/1/2020, CPEP Observation became an outpatient service
- ✤ Exhibit 32 - removed / no longer reported as inpatient
- ✤ Exhibit 33 - all utilization must be reported as outpatient
- Essential Plans (EP) - New Payor Categories
- ✤ EP 1 & 2 - patients whose services are covered under an Essential Plan who: meet certain income requirements; are not eligible for Medicaid or Child Health Plus; and do not have access to affordable employer coverage
- ✤ EP 3 & 4 - patients whose services are covered under an Essential Plan who: meet certain income requirements; are not eligible for Medicaid or Child Health Plus due to immigration status; and do not have access to affordable employer coverage
- ✤ Non-Medicaid, therefore not dual-eligible (Exhibit 30)
- Uninsured/Self pay - Clarification
- ✤ Self-pay primary payor - also includes individuals who have third-party insurance but elect to be billed directly
- Funded Depreciation
- ✤ Line 003 - Property, Plant & Equipment (PPE) purchases only
- ✤ Line 004 - PPE purchases correlate to change in depreciation fund
- ✤ Line 021 - adjusted for Depreciation Fund PPE purchases on line 004
- Reminders
- ✤ Recent spending will often increase funding requirement
- ✤ Consider spending from depreciation fund when appropriate
- ✤ Spending from depreciation fund for non-capital increases funding requirement
- ✤ Board-designation of funds does not satisfy funding requirement
- Line 002 - Outpatient Visits Fees - Clinic only
- ✤ Routine Gross Charges earned from services in the hospital's general clinic service area
- Line 013 - Outpatient Visits Fees - Other than General Clinic
- ✤ RHC & FQHC - routine charges for services provided in federally designated health clinic
- ✤ Use line 002 only if the patient transferred from a general clinic
- Uncollectible Amounts Section (previously Bad Debts)
- ✤ Change in title from "Bad Debts" to "Uncollectible Amounts" as a result of Accounting Standards Update (ASU) 606
- Update of rate codes for Medicaid Service code (MSC) mapping
- Deletions and Additions of rate codes for various MSCs
➣ ICR Schedule 4 (NEW)
- Non-Comparable Costs & Indirect Medical Education (IME)
- Ambulance Service Costs
- ✤ Question added to Exhibit 1 to prompt the display of these costs
- ✤ Must own or operate a hospital-based ambulance service
- ✤ Only applicable for Acute (MSC 201)
- School of Nursing Costs
- ✤ Based on Exhibit 1, Line 6000
- IME Factor
- ✤ Based on Exhibit 3 acute (non-exempt) interns & residents and bed days
- Ambulance Service Costs
➣ Edits
- Importance
- Improves Data Integrity
- ✤ Budgetary Analysis
- ✤ DSH Model
- Explains data anomalies
- ✤ Low Utilization
- ✤ Positive values entered as negatives & vice versa
- ✤ Charge Structure
- Reduce ICR Audit findings and/or questions
- ✤ Prevents errors to avoid audit findings
- ✤ Edit explanations provided to Auditors
- Improves Data Integrity
- Types
- Fatal (3xxxx)
- ✤ Identify the cause and make appropriate correction(s)
- ✤ Notify ICR mailbox when edit is believed non-applicable and cannot be cleared
- Non-Fatal (4xxxx)
- ✤ Intent is to identify unexpected data or combinations
- ✤ Correct data if entry is incorrect or omitted
- ✤ If edit identifies an unusual but appropriate condition, explain on Edit Report
- Fatal (3xxxx)
➣New Edits
- Related party responses differ
- No beds reported
- No Ancillary or Outpatient services reported
- ALC Days - include in Exhibits 3 & 32
- Courtesy Days/Employee Discount Days - include in Exhibits 3 & 32
- Medicare "Days" included in Exhibit 3 that are not considered inpatient days
- ✤ Labor & Delivery Days - do not include in Exhibit 32
- ✤ Non-distinct Observation Days (not admitted) - do not include in Exhibit 32
Note: Edits should be cleared BEFORE filing either Medicare or Medicaid cost report
- Use designated ICR lines for the following versus variable lines:
- ✤ Parking
- ✤ Malpractice insurance
- Days without discharges
- Discharges without days
- Discharges exceed days
- Total visits less than those admitted
- Emergency and CPEP Emergency
- ✤ No uninsured visits
- ✤ No Free (Charity) visits
- Negative utilization will not be allowed
- Only Medicaid FFS or Medicaid HMO reported but not both
- DSH and UPL payments should be negative amounts
- DSH Surcharge amounts
- ✤ Negative amount reported instead of positive
- ✤ Only inpatient or only outpatient amounts being reported
- ✤ Surcharges reported for non-surchargeable areas: SNF, HHA, etc.
- ✤ When amounts for non-General Clinic areas (such as Mental Health Clinic) on Line 002 are high in comparison to gross charges for that service area
- ✤ Line 002 should only be used for non-General Clinic areas when patient arrives in a General Clinic area then the encounter moves to the other non-General Clinic service area
- ICR Cost Centers:
- ✓ 235 Clinic
- ✓ 240, 250 Renal
- ✓ 472 Cancer Treatment
- ✓ 427-460 Variable when coded as MSC 235
- HFAL amounts
- ✤ Amounts missing
- ✤ Line amounts not being entered with the proper sign (+/-)
- ✤ Indigent Care reimbursement inconsistent with reporting on Exhibit 46
- Explain negative costs or make necessary corrections to underlying data
➣ Reminders
- 2021 ICR Submissions
- Please review past audit findings and/or adjustments to avoid similar reporting errors
- All remaining non-fatal edits must include adequate explanations and initials
- DCN #'s all agree - ICR submission, CFO certification and Edits
- Recommended - submit Financial statements, CFO certifications, Edits same day as ICR submission
- Initial ICR submission should always include the most accurate data
- ✤ Unaudited data may be used by the Department at any time
Questions?
ICR Questions: Hospital.ICR@health.ny.gov
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