Body of Report

30.7 - Body of Report (Rev. 175, Issued: 10-28-10, Effective: 04-01-11, Implementation: 04-04-11) SECTION F: INTEREST PAYMENT DATA The intermediary reports on Page 22 of the CMS-1566 data on the bills on which it paid interest because it paid the bills after the required payment date per §9311 of the Omnibus Budget Reconciliation Act of 1986. Counts of bills processed reflect their status as of the last workday of the reporting calendar month. The intermediary bases data shown on reliable counts of all bill processing activity and not on estimates. It reports data on initial bills only. Note that HH PPS RAPs with three-digit classification code 3- 2-2 or 3-3-2 with dates of service 10/01/2000 and greater are not subject to interest payment and should be excluded from this section. The intermediary includes all bills requiring interest payments in the month. It reports bills in the month the scheduled date of payment falls. See The Medicare Claims Processing, Chapter 1, General Billing Requirements, for a discussion of interest payments and the definition of scheduled payment date. It the report for each column as follows: • Column 1 - Total - It includes data for all bills for which interest payments were made in the reporting month. • Column 2 - Hospital - Of the bills reported in column 1, it shows in column 2 data for CMS-1450s submitted by hospitals for inpatient or outpatient services with the following two-digit classification codes in Form Locator 4: 1-1 (inpatient hospital) 1-2 (inpatient hospital - Part B benefits) 1-3 (outpatient hospital) 1-4 (hospital - other Part B benefits) 4-1 (Religious Nonmedical Health Care Hospital - inpatient) 4-2 (Religious Nonmedical Health Care Hospital - inpatient Part B benefits) 4-3 (Religious Nonmedical Health Care Hospital - outpatient) 4-4 (Religious Nonmedical Health Care Hospital - inpatient other) 8-3 (Outpatient hospital surgical procedures - ASC) • Column 3 - SNF--Of the bills reported in column 1, it shows in column 3 data for CMS- 1450s submitted with the following two-digit classification codes in Form Locator 4: 1-8 (hospital swing-bed) 2-1 (SNF - inpatient) 2-2 (SNF - inpatient Part B benefits) 2-3 (SNF - outpatient) 2-4 (SNF - other Part B benefits) 2-8 (SNF-swing-bed) 5-1 (Religious Nonmedical Health Care SNF - inpatient) 5-2 (Religious Nonmedical Health Care SNF - inpatient Part B benefits) 5-3 (Religious Nonmedical Health Care SNF - outpatient) 5-4 (Religious Nonmedical Health Care SNF - inpatient other) • Column 4 - HHA - Of the bills reported in column 1, it shows in column 4 data for CMS-1450s with the following two digit classification codes in Form Locator 4: 3-2, 3-3, and 3-4. • Column 5 - Hospice - Of the bills reported in column 1, it shows in column 5 data for CMS-1450s with the following two-digit classification codes in Form Locator 4: 8-1 and 8-2. • Column 6 - Remainder - Of the bills reported in column 1 it shows in column 6 data for all CMS-1450s not included in columns 2-5 (including provider and independent RHCs). On line 1, it shows the number of claims on which it paid interest in the reporting month. It reports on line 2 the number of claims included in line 1 for which it made payment one day after the required payment date (e.g., the required payment date is 25 days in FY 1999). Data for lines 3-10 are similar to those for line 2. It calculates the number of days late by subtracting the Julian date of receipt of the bill from the Julian scheduled payment date and then subtracting the required payment date (i.e., 25 in FY 1999). If the bill is paid in the year following the year of receipt, it adds 365 or 366 (if the year of receipt is a leap year) to the result, as appropriate. On line 11, it shows the amount paid in interest on the bills reported in line 1. See The Medicare Claims Processing Manual, Chapter 1, General Billing Requirements on how to calculate interest payments. On lines 12-20 it shows the amounts paid in interest for bills reported in lines 2-10, respectively. It shows payment amounts on lines 11-20 to the nearest penny, including the decimal point. Exhibit 1 Form CMS 1566 - Medicare Program Intermediary Workload Report, Page 1 Intermediary Name: Reporting Period: Intermediary Number: Number of Working Days: SECTION A: INITIAL BILL PROCESSING TOTAL (1) INPATIENT (2) OUTPATIENT (3) SNF (4) HHA (5) OTHER (6) Opening Pending 1. Opening Pending 2. Adjustments (+ or -) 3. Adj Opening Pending Receipts 4. Received during Month 5. Electronic Media Clearances 6. Total CWF Bills 7. Payment Approved 8. No Payment Approved 9. Total Non-CWF Bills 10. Payment Approved 11. No Payment Approved 12. Total Processed Closing Pending 13. Pending End of Month 14. Longer than 1 Month 15. Longer than 2 Months Exhibit 1 (Cont.) Form CMS 1566 - Medicare Program Intermediary Workload Report, Page 1 Intermediary Name: Reporting Period: Intermediary Number: Number of Working Days: SECTION A: INITIAL BILL PROCESSING TOTAL (1) INPATIENT (2) OUTPATIENT (3) SNF (4) HHA (5) OTHER (6) Bill Investigations 16. Investigations Init SECTION B: ADJUSTMENT BILLS CWF Clearances 17. Total CWF Processed 18. PRO Generated 19. Provider Generated 20. MSP 21. Other Non-CWF Clearances 22. Total Non-CWF Prcsd 23. PRO Generated 24. Provider Generated 25. MSP 26. Other Exhibit 1 (Cont.) Form CMS 1566 - Medicare Program Intermediary Workload Report, Page 1 Intermediary Name: Reporting Period: Intermediary Number: Number of Working Days: SECTION B: ADJUSTMENT BILLS TOTAL (1) INPATIENT (2) OUT PATIENT (3) SNF (4) HHA (5) OTHER (6) Pending 27. Total Pending 28. PRO Generated 29. Provider Generated 30. MSP 31. Other SECTION C: MEDICAID CROSSOVER BILLS Clearances 32. Trans to St Agencies 33. Trans Electronically SECTION D: MISCELLANEOUS DATA TOTAL BENEFICIARY PROVIDER Inquiries 34. Total Inquiries 35. Telephone 36. Walk-In 37. Written Exhibit 1 (Cont.) Form CMS 1566 - Medicare Program Intermediary Workload Report, Page 1 Intermediary Name: Reporting Period: Intermediary Number: Number of Working Days: SECTION D: MISCELLANEOUS DATA TOTAL (1) INPATIENT (2) OUTPATIENT (3) SNF (4) HHA (5) OTHER (6) OCR Bills 38. Total Received Bills Paid by HMOs 39. Total Processed Medicare Summary Notices 40. Total MSNs Mailed Exhibit 2 SECTION E(1): CLAIMS PROCESSING TIMELINESS - ALL CLAIMS Form CMS 1566 - Medicare Program Intermediary Workload Report, Pages 2-11 Intermediary Number: Bill Type: Report Month: ****** ******** **PAID** ******** ***NOT PAID*** **Non-PIP** ***PIP**** DAYS TO PROCESS TOTAL (1) CLEAN (2) OTHER (3) CLEAN (4) OTHER (5) CLEAN (6) OTHER (7) EMC (8) 1.1 2. 2 3. 3 4. 4 5. 5 6. 6 7. 7 8. 8 9. 9 10. 10 11. 11 12. 12 Exhibit 2 (Cont.) SECTION E(1): CLAIMS PROCESSING TIMELINESS--ALL CLAIMS Form CMS 1566 - Medicare Program Intermediary Workload Report, Pages 2-11 Intermediary Number: Bill Type: Report Month: ******* ******* ***PAID*** NOT PAID **Non-PIP** ****PIP**** DAYS TO PROCESS TOTAL (1) CLEAN (2) OTHER (3) CLEAN (4) OTHER (5) CLEA N (6) OTHE R (7) EMC (8) 13. 13 14. 14 15. 15 16. 16 17. 17 18. 18 19. 19 20. 20 21. 21 22. 22 23. 23 Exhibit 2 (Cont.) SECTION E(1): CLAIMS PROCESSING TIMELINESS--ALL CLAIMS Form CMS 1566 - Medicare Program Intermediary Workload Report, Pages 2-11 Intermediary Number: Bill Type: Report Month: ******** ******* **PAID** *NOT PAID* **Non-PIP** ****PIP**** DAYS TO PROCESS TOTAL (1) CLEAN (2) OTHER (3) CLEAN (4) OTHER (5) CLEA N (6) OTHE R (7) EM C (8) 24. 24 25. 25 26. 26 27. 27 28. 28 29. 29 30. 30 31. 31 32. 32 33. 33 Exhibit 2 (Cont.) SECTION E(1): CLAIMS PROCESSING TIMELINESS--ALL CLAIMS Form CMS 1566 - Medicare Program Intermediary Workload Report, Pages 2-11 Intermediary Number: Bill Type: Report Month: ******* ****** **PAID** **NOT PAID** **Non-PIP** ****PIP**** DAYS TO PROCESS TOTAL (1) CLEAN (2) OTHER (3) CLEAN (4) OTHER (5) CLEA N (6) OTHE R (7) EMC (8) 34. 34-45 35. 46-60 36. 61-90 37. 91+ 38. Total 39. Mean PT CMS-1566, Page Page number and bill type to be reported as follows: Page 2 - Inpatient Hospital (INP) Page 7 - CORF (COR) Page 3 - Outpatient (OUT) Page 8 - ESRD (ERD) Page 4 - SNF (SNF) Page 9 - Lab (LAB) Page 5 - HHA (HHA) Page 10 - Other (OTH) Page 6 - Hospice (HPC) Page 11 - Total (TOT) EXHIBIT 3 SECTION F: INTEREST PAYMENT DATA Form CMS 1566 - Medicare Program Intermediary Workload Report, Page 22 Intermediary Number: Report Month: BILLS/PAYMENTS DAYS LATE TOTAL (1) HOSPITAL (2) SNF (3) HHA (4) HOSPICE (5) REMAINDER (6) 1. Total Bills 2. 1 3. 2 4. 3 5. 4 6. 5 7. 6-15 8. 16-30 9. 31-60 10. 61+ 11. Total Paid 12. 1 13. 2 14. 3 15. 4 Exhibit 3 (Cont.) SECTION F: INTEREST PAYMENT DATA Form CMS 1566 - Medicare Program Intermediary Workload Report, Page 22 Intermediary Number: Report Month: BILLS/PAYMENTS DAYS LATE TOTAL (1) HOSPITAL (2) SNF (3) HHA (4) HOSPICE (5) REMAINDER (6) 16. 5 17. 6-15 18. 16-30 19. 31-60 20. 61+