Change Request 10484, Pub.100-20, Rev2357: Additional Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports FY 2004 and Earlier
Please click on the following link to read the attached Change Request (CR 10484) that was recently issued by CMS.
CMS Posting of CR 10484
Additional Instructions and Guidance to Hospitals Serviced by NGS
Providers who have open cost reports for a PRRB Remanded Appeal (for DSH SSI%), Pending Reopening Request (for DSH SSI%), or Cost Report that has not yet been final settled MUST MAKE AN ELECTION per CMS instructions. Failure to make an election will result in a delay in receiving your RNPR.
If the provider wishes to place the cost report on hold pending review of the patient level detail, you must notify NGS within 30 calendar days from the date these instructions are posted to the NGS website.
- Posted date is 10/18/2019, deadline to place on hold is 11/17/2019.
- Once cost report is placed on hold, the provider has 180 calendar days to notify NGS whether it wants to:
- Submit a request for a realigned Medicare-SSI fraction or
- Settle the cost report with a revised Medicare-SSI fraction based on the federal fiscal year.
- If a provider does not wish to place the cost report on hold to review the patient detail (or the provider has a federal fiscal year end of 9/30/xxxx), an election MUST still be made as to whether to have your SSI% calculated based on Total Days or Covered Days.
- Deadline to make an election is 4/15/2020.
a. See below for all of the information needed to make an election.
If a provider has previously made an election for a PRRB Remanded Appeal, NGS is requesting that you simply forward that election to us at NGSCostReportAppeal2@Anthem.com to ensure there are no delays in receiving your RNPR.
| Cost Reports that have been remanded from a PRRB Appeal | Cost Reports that have not yet been finalized (No NPR) | Cost Reports for which SSI Realignment is being requested |
|---|---|---|
| Provider Number | Provider Number | Provider Number |
| Hospital Name | Hospital Name | Hospital Name |
| PRRB Case Number (if applicable) | PRRB Case Number (if applicable) | PRRB Case Number (if applicable) |
| PRRB Remand Date (if applicable) | PRRB Remand Date (if applicable) | PRRB Remand Date (if applicable) |
| Case Name, Docket Number (if applicable) | Case Name, Docket Number (if applicable) | Case Name, Docket Number (if applicable) |
| Hospital’s designated representative (if applicable) | Hospital’s designated representative (if applicable) | Hospital’s designated representative (if applicable) |
| Cost Report Begin Date (YYYYMMDD) | Cost Report Begin Date (YYYYMMDD) | Cost Report Begin Date (YYYYMMDD) |
| Cost Report End Date (YYYYMMDD) | Cost Report End Date (YYYYMMDD) | Cost Report End Date (YYYYMMDD) |
| FFY Based on CR Begin Date (YYYY) | FFY Based on CR Begin Date (YYYY) | FFY Based on CR Begin Date (YYYY) |
| Provider Election (“Total” or “Covered”) | Provider Election (“Total” or “Covered”) | Provider Election (“Total” or “Covered”) |
| SSI Ratio Selected (Numerical value from CMS website) | SSI Ratio Selected (Numerical value from CMS website) |
Provider inquiries, requests, elections, etc. related to this CMS Change Request should be directed to:
-
- If your request is associated with a PRRB Remanded Appeal (Jurisdictions J6, JK or JM, please send requests to NGSCostReportAppeal2@Anthem.com
- If your request is associated with a cost report reopening or request for SSI Realignment or to place the cost report on hold to review the patient level detail (Jurisdictions J6 and JK), please send requests to cost.report.reopenings@anthem.com
- If your request is associated with a JK cost report that is not yet finalized, please send requests to:
Revised 1/23/2020
Posted 10/15/2019