Blank – Transition Blend no longer

8 - Blank – Transition Blend no longer applies with cost reporting periods beginning in on or after 10/01/2019. Full Site Neutral payment Data Element File Position Format Title Description IPF PPS: Enter the appropriate code for the blend ratio between federal and facility rates. Effective for all IPF providers with cost reporting periods beginning on or after 1/1/2005. Federal % Facility% 1 25 75 2 50 50 3 75 25 4 100 00 19 76-77 9(2) State Code Enter the 2-digit state where the provider is located. Enter only the first (lowest) code for a given state. For example, effective October 1, 2005, Florida has the following State Codes: 10, 68 and 69. MACs shall enter a “10” for Florida’s state code. List of valid state codes is located in Pub. 100-07, Chapter 2, Section 2779A1. 20 78-80 X(3) Filler Blank. 21 81-87 9(5)V9(2) Case Mix Adjusted Cost Per Discharge/PPS Facility Specific Rate For PPS hospitals and waiver state non- excluded hospitals, enter the base year cost per discharge divided by the case mix index. Enter zero for new providers. See §20.1 for sole community and Medicare- dependent hospitals on or after 04/01/90. For inpatient PPS hospitals, verify if figure is greater than $10,000. For LTCH, verify if figure is greater than $35,000. 22 88-91 9V9(3) Cost of Living Adjustment (COLA) Enter the COLA. All hospitals except Alaska and Hawaii use 1.000. 23 92-96 9V9(4) Intern/Beds Ratio Enter the provider's intern/resident to bed ratio. Calculate this by dividing the provider's full time equivalent residents by the number of available beds (as calculated in positions 97-101). Do not include residents in anesthesiology who are employed to replace anesthetists or those assigned to PPS excluded units. Base the count upon the average number of full-time equivalent residents assigned to the hospital during the fiscal year. Correct cases where there is reason to believe that Data Element File Position Format Title Description the count is substantially in error for a particular facility. The MAC is responsible for reviewing hospital records and making necessary changes in the count at the end of the cost reporting period. Enter zero for non-teaching hospitals. IPF PPS: Enter the ratio of residents/interns to the hospital’s average daily census. 24 97-101 9(5) Bed Size Enter the number of adult hospital beds and pediatric beds available for lodging inpatient. Must be greater than zero. (See the Provider Reimbursement Manual, §2405.3G.) 25 102-105 9V9(3) Operating Cost to Charge Ratio Derived from the latest settled cost report and corresponding charge data from the billing file. Compute this amount by dividing the Medicare operating costs by Medicare covered charges. Obtain Medicare operating costs from the Medicare cost repot form CMS-2552-96, Supplemental Worksheet D-1, Part II, Line 53. Obtain Medicare covered charges from the MAC billing file, i.e., PS&R record. For hospitals for which the MAC is unable to compute a reasonable cost-to-charge ratio, they use the appropriate urban or rural statewide average cost-to-charge ratio calculated annually by CMS and published in the "Federal Register." These average ratios are used to calculate cost outlier payments for those hospitals where you compute cost-to-charge ratios that are not within the limits published in the "Federal Register." For LTCH and IRF PPS, a combined operating and capital cost-to-charge ratio is entered here. See below for a discussion of the use of more recent data for determining CCRs. Data Element File Position Format Title Description 26 106-110 9V9(4) Case Mix Index The case mix index is used to compute positions 81-87 (field 21). Zero-fill for all others. In most cases, this is the case mix index that has been calculated and published by CMS for each hospital (based on 1981 cost and billing data) reflecting the relative cost of that hospital's mix of cases compared to the national average mix. 27 111-114 V9(4) Supplemental Security Income Ratio Enter the SSI ratio used to determine if the hospital qualifies for a disproportionate share adjustment and to determine the size of the capital and operating DSH adjustments. 28 115-118 V9(4) Medicaid Ratio Enter the Medicaid ratio used to determine if the hospital qualifies for a disproportionate share adjustment and to determine the size of the capital and operating DSH adjustments. 29 119 X(1) Provider PPS Period This field is obsolete as of 4/1/91. Leave Blank for periods on or after 4/1/91. 30 120-125 9V9(5) Special Provider Update Factor Zero-fill for all hospitals after FY91. This Field is obsolete for hospitals as of FY92. Effective 1/1/2018, this field is used for HHAs only. Enter the HH VBP adjustment factor provided by CMS for each HHA. If no factor is provided, enter 1.00000. 31 126-129 V9(4) Operating DSH Disproportionate share adjustment Percentage. Pricer calculates the Operating DSH effective 10/1/91 and bypasses this field. Zero-fill for all hospitals 10/1/91 and later. 32 130-137 9(8) Fiscal Year End This field is no longer used. If present, must be CCYYMMDD. 33 138 X(1) Special Payment Indicator Enter the code that indicates the type of special payment provision that applies. Blank = not applicable Y = reclassified 1 = special wage index indicator 2 = both special wage index indicator and reclassified D = Dual reclassified Data Element File Position Format Title Description 34 139 X(1) Hospital Quality Indicator Enter code to indicate that hospital meets criteria to receive higher payment per MMA quality standards. Blank = hospital does not meet criteria 1 = hospital quality standards have been met 35 140-144 X(5) Actual Geographic Location Core-Based Statistical Area (CBSA) Enter the appropriate code for the CBSA 00001-89999, or the rural area, (blank (blank) (blank) 2 digit numeric State code such as _ _ _ 36 for Ohio, where the facility is physically located. 36 145-149 X(5) Wage Index Location CBSA Enter the appropriate code for the CBSA, 00001-89999, or the rural area, (blank)(blank) (blank) (2 digit numeric State code) such as _ _ _ 3 6 for Ohio, to which a hospital has been reclassified due to its prevailing wage rates. Leave blank or enter the actual location CBSA (field 35), if not reclassified. Pricer will automatically default to the actual location CBSA if this field is left blank. 37 150-154 X(5) Payment CBSA Enter the appropriate code for the CBSA, 00001-89999 or the rural area, (blank) (blank)(blank) (2 digit numeric State code) such as _ _ _ 3 6 for Ohio, to which a hospital has been reclassified. Leave blank or enter the actual location CBSA (field 35) if not reclassified. Pricer will automatically default to the actual location CBSA if this field is left blank 38 155-160 9(2)V9(4) Special Wage Index Enter the special wage index that certain providers may be assigned. Enter zeroes unless the Special Payment Indicator field equals a “1” or “2.” 39 161-166 9(4)V9(2) Pass Through Amount for Capital Per diem amount based on the interim payments to the hospital. Must be zero if location 185 = A, B, or C (See the Provider Reimbursement Manual, §2405.2). Used for PPS hospitals prior to their cost reporting period beginning in FY 92, new hospitals during their first 2 years of operation FY 92 or later, and non-PPS Data Element File Position Format Title Description hospitals or units. Zero-fill if this does not apply. 40 167-172 9(4)V9(2) Pass Through Amount for Direct Medical Education Per diem amount based on the interim payments to the hospital (See the Provider, Reimbursement Manual, §2405.2.). Zero- fill if this does not apply. 41 173-178 9(4)V9(2) Pass Through Amount for Organ Acquisition Per diem amount based on the interim payments to the hospital. Include standard acquisition amounts for kidney, heart, lung, pancreas, intestine and liver transplants. Do not include acquisition costs for bone marrow transplants. (See the Provider Reimbursement Manual, §2405.2.) Zero- fill if this does not apply. 42 179-184 9(4)V9(2) Total Pass Through Amount, Including Miscellaneous Per diem amount based on the interim payments to the hospital (See the Provider Reimbursement Manual §2405.2.) Must be at least equal to the three pass through amounts listed above. The following are included in total pass through amount in addition to the above pass through amounts. Supply Chain Costs, Certified Registered Nurse Anesthetists (CRNAs) are paid as part of Miscellaneous Pass Through for rural hospitals that perform fewer than 500 surgeries per year, and Nursing and Allied Health Professional Education when conducted by a provider in an approved program. Do not include amounts paid for Indirect Medical Education, Hemophilia Clotting Factors, DSH adjustments, or Allogeneic Stem Cell Acquisition. Zero-fill if this does not apply. 43 185 X(1) Capital PPS Payment Code Enter the code to indicate the type of capital payment methodology for hospitals: A = Hold Harmless – cost payment for old capital B = Hold Harmless – 100% Federal rate C = Fully prospective blended rate 44 186-191 9(4)V9(2) Hospital Specific Capital Rate Must be present unless: • A "Y" is entered in the Capital Indirect Medical Education Ratio field; or Data Element File Position Format Title Description • A“08” is entered in the Provider Type field; or • A termination date is present in Termination Date field. Enter the hospital's allowable adjusted base year inpatient capital costs per discharge. This field is not used as of 10/1/02. 45 192-197 9(4)V9(2) Old Capital Hold Harmless Rate Enter the hospital's allowable inpatient "old" capital costs per discharge incurred for assets acquired before December 31, 1990, for capital PPS. Update annually. 46 198-202 9V9(4) New Capital- Hold Harmless Ratio Enter the ratio of the hospital's allowable inpatient costs for new capital to the hospital's total allowable inpatient capital costs. Update annually. 47 203-206 9V9(3) Capital Cost-to- Charge Ratio Derived from the latest cost report and corresponding charge data from the billing file. For hospitals for which the MAC is unable to compute a reasonable cost-to- charge ratio, it uses the appropriate statewide average cost-to-charge ratio calculated annually by CMS and published in the "Federal Register." A provider may submit evidence to justify a capital cost-to- charge ratio that lies outside a 3 standard deviation band. The MAC uses the hospital's ratio rather than the statewide average if it agrees the hospital's rate is justified. See below for a detailed description of the methodology to be used to determine the CCR for Acute Care Hospital Inpatient and LTCH Prospective Payment Systems. 48 207 X(1) New Hospital Enter "Y" for the first 2 years that a new hospital is in operation. Leave blank if hospital is not within first 2 years of operation. 49 208-212 9V9(4) Capital Indirect Medical Education Ratio This is for IPPS hospitals and IRFs only. Enter the ratio of residents/interns to the hospital's average daily census. Calculate by dividing the hospital's full-time equivalent total of residents during the fiscal year by the hospital's total inpatient days. (See §20.4.1 for inpatient acute Data Element File Position Format Title Description hospital and §§140.2.4.3 and 140.2.4.5.1 for IRFs.) Zero-fill for a non-teaching hospital. 50 213-218 9(4)V9(2) Capital Exception Payment Rate The per discharge exception payment to which a hospital is entitled. (See §20.4.7 above.) 51 219-219 X VBP Participant Enter “Y” if participating in Hospital Value Based Purchasing. Enter “N” if not participating. Note if Data Element 34 (Hospital Quality Ind) is blank, then this field must = N. 52 220-231 9V9(11) VBP Adjustment Enter VBP Adjustment Factor. If Data Element 51 = N, leave blank. 53 232-232 X HRR Indicator Enter “0” if not participating in Hospital Readmissions Reduction program. Enter “1” if participating in Hospital Readmissions Reduction program and payment adjustment is not 1.0000. Enter “2” if participating in Hospital Readmissions Reduction program and payment adjustment is equal to 1.0000. 54 233-237 9V9(4) HRR Adjustment Enter HRR Adjustment Factor if “1” is entered in Data Element 53. Leave blank if “0” or “2” is entered in Data Element 53. 55 238-240 V999 Bundle Model 1 Discount Enter the discount % for hospitals participating in Bundled Payments for Care Improvement Initiative (BPCI), Model 1 (demo code 61). 56 241-241 X HAC Reduction Indicator Enter a ‘Y’ if the hospital is subject to a reduction under the HAC Reduction Program. Enter a ‘N’ if the hospital is NOT subject to a reduction under the HAC Reduction Program. 57 242-250 9(7)V99 Uncompensated Care Amount Enter the estimated per discharge uncompensated care payment (UCP) amount or enter the total of the estimated per discharge UCP amount and estimated per discharge supplemental payment amount, calculated and published by CMS for each hospital. Effective 10/1/2022, the estimated per discharge supplemental payment is for eligible Indian Health Service/Tribal hospitals and hospitals located in Puerto Rico. Data Element File Position Format Title Description 58 251-251 X Electronic Health Records (EHR) Program Reduction Enter a ‘Y’ if the hospital is subject to a reduction due to NOT being an EHR meaningful user. Leave blank if the hospital is an Electronic Health Records meaningful user. 59 252-258 9V9(6) LV Adjustment Factor Enter the low-volume hospital payment adjustment factor calculated in accordance with the low-volume hospital payment regulations at § 412.101. 60 259-263 9(5) County Code Enter the County Code. Must be 5 numbers. 61 264-268 9V9999 Medicare Performance Adjustment (MPA) Enter the MPA percentage calculated and published by the Centers for Medicare & Medicaid Services (CMS). 62 269-269 X(1) LTCH DPP Indicator Enter a ‘Y’ if the LTCH is subject to the DPP payment adjustment. Leave blank if the LTCH is not subject to the DPP payment adjustment. 63 270-275 9(2) V9(4) Supplemental Wage Index Enter the supplemental wage index that certain providers may be assigned. Enter zeroes if it does not apply. 64 276-276 X(1) Supplemental Wage Index Flag Enter the supplemental wage index flag that certain providers may be assigned: 1=Prior Year Wage Index 2=Special IPPS-comparable Wage Index* 3=Future use Enter blank if it does not apply *Only for LTCH providers. Pricer will override the otherwise determined IPPS- comparable wage index with this value. 65 277-285 9(7)V99 Pass Through Amount for Allogeneic Stem Cell Acquisition Enter the per diem amount based on the interim payments to the hospital. Include acquisition amounts for allogeneic stem cell transplants. Zero-fill if this does not apply. Data Element File Position Format Title Description 66 286-291 9(4)V9(2) Pass Through Amount for Direct Graduate Medical Education (Medicare Advantage (MA) Exclusion) Per diem amount of direct graduate medical education to be excluded from MA capitation rates per regulation. Zero-fill if this does not apply. 67 292-297 9(4)V9(2) Pass Through Amount for Kidney Acquisition (MA Exclusion) Per diem amount of kidney acquisition costs to be excluded from MA capitation rates per regulation. Zero-fill if this does not apply. 68 298-306 9(7)V99 Pass Through Amount for Supply Chain Costs Enter the per diem amount based on the interim payments to the hospital. Include payment adjustments for the additional resource costs of establishing and maintaining access to buffer stocks of essential medicines. Also Include payment adjustments for the additional cost for procurement of wholly domestically made NIOSH-approved surgical N95 respirators. 69 307-310 X(4) Filler