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

  • ➣ 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
    • 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
  • ➣ 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
    • 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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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
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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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2021 ICR Updates

  • ➣ Exhibits (changes, additions & clarifications)
  • Exhibit 1
    • 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
  • Exhibit 14
    • Interest Rate Swaps
      • ✤ Interest rate swaps must be adjusted out prior to applying investment income
  • Exhibit 16
    • Related-Party Interest
      • ✤ Instructions updated
      • ✤ Related interest-bearing arrangement between one hospital to related hospital/entity
  • Exhibit 18
    • 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
  • Exhibits 32 & 33
    • 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
  • Exhibits 32, 33, 34 & 46 (also Schedule 2)
    • 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
  • Exhibit 41
    • 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
  • Exhibit 46
    • 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
  • Appendix I of ICR Instructions
    • 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
      Note: Direct Medical Education (DME) costs will be added to Schedule 4 in the future

    ➣ 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
    • 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

    ➣New Edits

  • Exhibits 1 and 16
    • Related party responses differ
  • Exhibit 2 - Profile of Services
      • No beds reported
      • No Ancillary or Outpatient services reported
    • Exhibits 3 and 32
        • 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
        • Hospice Days - do not include in Exhibit 32
        • Swing Bed Days - do not include in Exhibit 32 (only Exhibit 30)
          Note: Edits should be cleared BEFORE filing either Medicare or Medicaid cost report
      • Exhibit 18
        • Use designated ICR lines for the following versus variable lines:
          • ✤ Parking
          • ✤ Malpractice insurance
        • Expenses reported as negative amounts
        • Incomplete offsets
      • Exhibit 32
        • Days without discharges
        • Discharges without days
        • Discharges exceed days
      • Exhibit 33
        • Total visits less than those admitted
        • Emergency and CPEP Emergency
          • ✤ No uninsured visits
          • ✤ No Free (Charity) visits
        • Exhibits 32, 33 & 34
          • Negative utilization will not be allowed
          • Only Medicaid FFS or Medicaid HMO reported but not both
        • Exhibit 46
          • 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.
          • No charges when active service area has costs
          • Line 002 - Outpatient Visit Fees Clinic Only
            • ✤ 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
          • General Clinic includes:
                    ICR Cost Centers:      

              • ✓ 235 Clinic
              • ✓ 240, 250 Renal
              • ✓ 472 Cancer Treatment
              • ✓ 427-460 Variable when coded as MSC 235
          • Exhibit 50
            • HFAL amounts
              • ✤ Amounts missing
              • ✤ Line amounts not being entered with the proper sign (+/-)
              • ✤ Indigent Care reimbursement inconsistent with reporting on Exhibit 46
          • Exhibit 52
            • 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
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          Questions?

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

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