2018 Institutional Cost Report (ICR) Updates

NYS Department of Health

April 2019

Agenda

  • 2018 ICR Updates
  • Cost Reporting Accuracy & Clarifications
  • Future Cost Report Developments
  • Software, Support & Filing Procedures
  • ICR Audits & Audit Fees
  • Health Commerce System & Public Website
  • Questions

2018 ICR Updates

  • No changes to the Exhibits for 2018
  • Updated Instructions
    • Clarifications for common reporting errors
  • Updated Q&A´s

Cost Reporting Accuracy & Clarifications

  • Importance of Data Integrity
    • Rate Setting
    • Financial Analysis
    • Upper Payment Limit (UPL) / Disproportionate Share Limit (DSH)
    • Pool Distributions
  • Medicaid Service Code (MSC) Assignments
    • Cost Centers assigned to the appropriate MSC´s
      • Refer to Appendix I of the ICR Instructions
    • Complete in Sequence
      • Exhibit 52 – all costs must be assigned a MSC
      • Exhibit 46 – charges will automatically be assigned
      • Exhibit 32 & 33 – MSC´s utilized on Exh 52 will be available
    • Review the Alignment of Costs, Charges & Statistics on Exh 53
  • Capital Reporting
    • Exhibit 41 - Funded Depreciation
      • Must be completed by Voluntary Hospitals (Part 86-1.25)
      • Blank or negative values for purchases & capital debt payment
      • Inconsistent with Statement of Cash Flows
    • Exhibit 44 - Direct Charge Capital
      • Must have an opening stepdown balance for associated cost center
  • Utilization Reporting
    • Exhibit 30 – Inpatient & Swing Bed Statistics
      • All Payor Days & Discharges for Dual Eligible
        • "Medicaid" or "HMO/ PHSP Medicaid" considered secondary payor (not primary)
        • No Essential Plans (considered "HMO/PHSP Other")
        • Total Days & Discharges should not be greater than Exhibit 32
      • Alternative Level of Care (ALC) should be reported for Acute only
    • Exhibit 32 – Inpatient Patient Days & Discharges
      • FIDA & FIDA-IDD – report under "HMO / PHSP Medicaid"
      • Essential Plans – report under "HMO / PHSP Other"
    • Exhibit 33 – Outpatient Patient Visits
      • Rural Health Clinics – report under "FQHC" service area
      • Personalized Recovery Oriented Services (PROS) – report months vs visits
    • Exhibit 34 – Home Health Services
      • Only Hospital-Based Home Health Agencies should be reporting
      • Include NYS Home Health Agency Operating Certificate on exhibit
    • Charges Reporting
      • Exhibit 46 – Patient Service Revenue
        • Routine charges - Charges follow the patient
        • Inpatient admits reported on appropriate routine service line under the Inpatient Service category where the patient was transferred
      • Exhibit 51 – Ratio of Costs to Charges
        • Part I-A Adjustment to Charges
          • Carve-out for Drugs outside of rate or Physician Fees should be reported as negative values
        • Part II – Inpatient Charge Mapping
          • Revenue codes mapped to a cost center group (CCG) which has no RCC (Part IC)

Future Cost Report Developments

  • The Department is still working towards incorporating the following cost and statistical schedules, which are used in rate development, into the 2019 cost report:
    • Schedule 1 – Allowable Operating & Transfer Costs by Service
    • Schedule 2 – Statistical Summaries for Inpatient & Outpatient Services
    • Schedule 3 – Allowable Capital Costs by Service
  • Exhibit 42 (Unfunded Depreciation Waiver) – New Section
    • Alternate Funding Schedule – populates ICR financial data to determine an automatic waiver of a penalty to the funding of depreciation
  • New edits to prevent or highlight possible reporting errors prior to submission

Obtaining Software and Support

  • Software will be available for download from the KPMG Compu-Max website.
    Note: The Department will provide hospitals with the URL, Username and Password using the Health Commerce System (HCS)
  • ICR problem resolution and questions:
    • Hospital.ICR@health.ny.gov
      (Note: please do not send via secure email - DOH security prohibits these emails)
    • For problem resolution, send your "four-pack" files (CR, IC, B_, T_) to this address. The files will then be forwarded to KPMG, if necessary.

Electronic Filing Procedures

  • DH file (HCS electronic submission):
    • Due date: Friday, May 31, 2019
  • Electronic submission of documents within 5 Business days of electronic DH file submission:
    • Signed CEO certification
    • Edit Report (Initialed with explanations)
    • 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
  • Edit Report (initialed with explanations):
    • File named with 7 digit operating certificate number and "_Edits"
      • Example: 1234567_Edits
  • Audited Financial Statements:
    • File named with 7-digit operating certificate number and "_AFS"
      • Example: 1234567_AFS

ICR Audits

  • KPMG awarded the contract for the ICR audits
  • 2016 & 2017 ICR Audits
    • Both audits will be done simultaneously
    • Only desk audits will be performed for both years
    • ICR audit tools expected to be released in early May (kickoff webinar in April)
    • Providers can complete the Audit Tool questionnaire during May and June
    • Final audited reports submitted, and audits fully completed by the end of September
  • 2018 ICR Audit
    • ICR audit tool expected to be released in October

Note: the timeline of the 2018 ICR audit is subject to change pending the start date of the 2016 DSH Audit

ICR Audit Fees

  • Due at time of filing
  • Same fee schedule as previous years
    • The fee schedule may be subject to change for 2019
  • 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
  • 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

Department of Health Public Website

Questions?

(Future ICR Questions: Hospital.ICR@health.ny.gov)