2019 Institutional Cost Report (ICR)

NYS Department of Health
Division of Finance & Rate Setting
Bureau of Hospital & Clinic Rate Setting

June 16, 2020

Agenda

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).
  • 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, July 31, 2020
      • Extended due to COVID-19 emergency
    • 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
    • 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
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2019 ICR Audit Fees

  • ➣ Due at time of filing
  • ➣ Same fee schedule as previous years
    • The fee schedule may be subject to change for 2020
  • ➣ Same payment process as previous years
  • ➣ Email notification to be released for facility-specific fees
  • ➣ Fee schedule

✤Note: For the 2018 ICR audit, hospitals with a field audit for DSH are not scheduled for a 2018 ICR field audit.

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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
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Department of Health Public Website

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Cost Reporting Accuracy

  • ➣ Importance of Data Integrity
    • Rate Setting
    • Financial Analysis
    • Upper Payment Limit (UPL) / Disproportionate Share Limit (DSH)
    • Pool Distributions
  • ➣ ICR Instructions
    • Updated to incorporate prior Q&As and provide clarifications
  • ➣ Q&As
    • Provides information that is not directly tied to the cost report and not incorporated into the instructions.
  • ➣ Data Integrity
    • Many new edits
      • Some fatal, most non-fatal/informational
      • Help provide direction that something may be reported incorrectly
      • Edit will not result if data does not trigger it
    • Examples
      • Exhibit 32, 33 & 34 – Negative uncompensated care collections
      • Exhibit 33 – Visits excluding inpatient admissions > visits including [fatal]
      • Exhibit 41 – Compare to Statement of Cash Flows in Exhibit 25
      • Exhibit 46 – Negative surcharge and assessment payments
      • Exhibit 51 – Negative total charges or costs for RCCs
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2019 ICR Updates / Clarifications

  • ➣ Updates / Clarifications for 2019
    • Reporting: Rural Health Center (RHC) Cost Centers
    • Reporting: Article 16 (OPWDD) Clinic Cost Center
    • Exhibit 30: Inpatient Dual-eligible & Swing Beds (Update)
    • Exhibit 42: Waiver of Depreciation Funding (Update)
    • Exhibit 46: Revenue by Service Area (Update & Clarification)
    • Exhibit 52 (Update & Clarification)
    • Exhibit 53 (Update)
  • ➣ Reporting
    • Rural Health Center (RHC)
      • For NYS, RHC = Federally Qualified Health Center (FQHC)
      • RHC cost center works the same as the FQHC for NYS
      • ICR lines 467-471 & 461-465, Exhibit 46 Charge Codes 4896-4900 & 4890-4894, MSC 287
    • Article 16 (OPWDD) Clinic Cost Center
      • ICR line 466, Exhibit 46 Charge Code 4895, MSC 261
  • ➣ Exhibit 30 – Inpatient and Swing Bed Statistics (Update)
    • Inpatient Dual-Eligible Statistics
      • Report total days and discharges only
        • Eliminated some reported data
      • Include ALC days
    • Swing Bed Statistics
      • Expanded hard-coded payor names
  • ➣ Exhibit 42 – Waiver of Depreciation Funding (Update)
    • Active only when Exhibit 41 results in unfunded depreciation penalty
      • Even though Exhibit 42 may be active, the proposed waiver amount will not be accepted during the audit process unless a complete justification of the waiver request is provided (text box Exhibit 42)
      • Justification provides the basis as to why the Department should accept the Exhibit 42 waiver request
    • Depreciation Funding Schedule (Sections A & B)
      • Provides for input of other depreciation and cash flow
    • Waiver Eligibility Schedule (Section D)
      • If AFS does not report salaries or taxes payable – ability to input data provided
    • Status of unfunded depreciation penalty after Exhibit 42 is completed
      • If qualified for a full waiver on Exhibit 42 and a complete justification for the request is provided, then waiver request process is completed
      • If there is still a remaining penalty:
        • ✓ Department reviews during audit and may reduce penalty
        • ✓ Hospital will be notified by auditor of penalty reduction
        • ✓ If penalty reduced, include in post-audit ICR resubmission
      • Any remaining penalty flows to ICR Schedule 3 (Capital Schedule)
  • ➣ Exhibit 46 - Revenue by Service Area
    • Expanded Primary Payor reporting for a hospital´s defined "Charity Care"
      • Hospital provided financial assistance for an encounter where Charity Care was not the Primary Payor
        • ✓ Line 382 – Medicaid FFS
        • ✓ Line 386 – PHSP/HMO Medicaid
        • ✓ Line 383 – Insured
        • ✓ Line 391 – Uninsured/Self-Pay
    • For a hospital´s defined "Charity Care" that does not meet the Charity Care encounter definition (see next screen for Charity Care definition)
  • Charity Care reporting affects Exhibits 32, 33, 34 and 46
    • A Charity Care encounter is:
      • Financial Assistance with NO Insurance
      • Charity (Free, Hill-Burton) is the Primary Payor
      • One determination of insured or not insured for the entire admission/account (cannot split charges)
      • An individual´s insurance does not cover any of the services received
    • A Charity Care encounter is NOT:
      • A coverage limit or benefits exhaustion during the service
      • A denial for hospital errors (timely billing, pre-authorization, etc.)
      • A partial write-off after insurance
  • ➣ Exhibit 52: Effect on Exhibits 32 & 33
    • Exhibit 32 – Patient Days & Discharges by Source of Payment
      • MSC selection limited to Inpatient defined MSCs used on Exhibit 52 or MSC 959 (non-reimbursable)
      • DOH-certified exempt units should not be combined with MSC 201 or 216
      • If no MSC assigned, assumes MSC 959
    • Exhibit 33 – Statistical Data & Patient Visits by Source of Payment
      • MSC selection limited to Outpatient defined MSCs used on Exhibit 52 or MSC 959 (non-reimbursable)
      • If no MSC assigned, assumes MSC 959
  • ➣ Exhibit 52 – Medicaid Allocated Cost Service Code Assignment
    • Medicaid Service Code (MSC) Assignments
      • Every cost center with costs requires a MSC assignment
      • MSC 959: Non-Reimbursable / Non-Billable / Not Included in Rate Development
        • ✤ Means: The Hospital Rate Setting bureau does not use in rate setting nor has the
               data been requested to be discretely identified for another Office/Agency.
      • No MSC assigned for a variable cost center, assumes MSC 959 – editable
  • ➣ Exhibit 53: Medicaid Service Code Assignment Summary
    • Addressed any formula issues and sections that were previously greyed-out in error
    • Review for missing services, costs, revenue or statistics
    • Review for unusual values or ratios
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New ICR Schedules

  • ➣ The ICR Schedules require:
    • MSCs assigned to statistics, costs & charges
    • Change to the charge basis for transfer costs, if applicable
    • The ICR software will automatically calculate the schedules
  • ➣ ICR Schedule 1 – Allowable Costs
    • ICR Schedule 1A – Service Area Transfer Summary
    • ICR Schedule 1B – Transfers by Service Area
  • ➣ ICR Schedule 2 – Utilization
    • Inpatient & Outpatient Statistics by Payor
  • ➣ ICR Schedule 3 – Capital Cost & Distribution
    • Part 1 – Total Allowable Capital
    • Part 2 – Distribution to Service Areas
  • ➣ ICR Schedule 1 – Allowable Costs
    • Order of operations: 1B then 1A, then 1
      • ICR Schedule 1B – Calculates Transfer Costs for 3 Service Areas
      • ICR Schedule 1A – Summarizes the ICR Schedule 1B Transfer Costs
      • ICR Schedule 1 – Calculates Allowable Costs after Transfer Costs
    • 3 Transfer Service Areas:
      • Emergency Department
      • Clinic
      • CPEP
  • ➣ ICR Schedule 1B: Calculates Transfer costs for 3 Service Areas
    • Visits or Charges basis used for Allocation
      • If currently using Charges as the basis, will remain on Charges
        • ✓ Flag already set in the ICR
      • If using Visits as the basis, ability to test the Charges basis
      • Once an ICR is submitted using Charges, cannot switch to Visits
    • Summarizes Charges or Visits based on MSC assignments (see exceptions – next slide)
      • Exhibit 46 for Charges (By Charge Code)
        • ✓ Line 002 Clinic, Line 003 ED, Line 014 CPEP
      • Exhibit 31A for Visits (By Cost Center)
    • Exceptions to MSC Assignment Summarization
      • The charges or visits totals used for the 3 Service Areas will be the following versus the hospital´s MSC assignments:
        Service Area Exhibit 31A Cost Center Exhibit 46 Charge Code
        Clinic
        Emergency
        CPEP        		 235, 240, 291, 472
        236, 260, 417
        288        		 00026, 00383, 00387, 04901
        00027, 00030, 04846
        00385
  • ➣ ICR Schedule 1A – Summarizes the ICR Schedule 1B Transfer Costs
    • Combines the 3 Service Areas:
      • Total Transfer Costs
      • Total Transfer Capital
  • ➣ ICR Schedule 1 – Calculates Allowable Costs after Transfer Costs
    • Final Stepdown Costs (Exhibit 52 MSC coding)
    • Adds/Subtracts Transfer Costs (Schedule 1A)
    • Allowable Costs (Includes Capital)
  • ➣ Review for expected Allowable Costs
  • ➣ ICR Schedule 2 - Utilization
    • Inpatient, Outpatient and Swing Bed Statistics by Payor
      • Source: Exhibits 32, 33 (Excl. Inpatient column) & 34
      • Based on MSC assignments
    • Sums by MSC for each Service Area & Primary Payor
    • Multiple totals provided
      • Totals exclude ADHC
  • ➣ Review for expected Utilization
  • ➣ ICR Schedule 3 – Capital Cost & Distribution
    • Part 1 – Total Allowable Capital
      • Calculates Total Facility Reported Capital, Non-Projectable Capital & Allowable Capital
        • ✓ Based on capital-related costs, direct charge and variable capital
      • Adjusts Total Reported Capital for:
        • ✓ Property taxes and insurance
        • ✓ Unfunded Depreciation (net of waiver - Exhibit 42, if applicable)
        • ✓ Limitation on Major Moveable Equipment (Article 28)
    • Part 2 – Distribution to Service Areas
      • Total Reported
        • ✓ Sums by MSC for each Service Area
          • Source: Exhibit 52 MSC assignments
      • Allocates Non-Projectable Capital & Major Moveable Equipment Limitation based on % to Total
      • Applies Transfer Capital Costs (ICR Schedule 1)
  • ➣ Review for expected Capital Cost & Distribution
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Questions?

ICR Questions: Hospital.ICR@health.ny.gov

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