Blog, Reimbursement, The Hospital Finance Podcast®

Medicare Cost Report Worksheet S-10 Explained [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Jimmy Mendez, Senior Manager at BESLER, to discuss an increasingly important part of uncompensated care reimbursement: Worksheet S-10.       

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Highlights of this episode include:

  • Why Worksheet S-10 has become so important to the Medicare cost report.
  • What key data files are needed to initiate preparation of Worksheet S-10?
  • Why transactions such as patient accounting transaction detail and charge detail are most critical in preparing Worksheet S-10.
  • What issues can arise during an audit that can jeopardize the integrity of the supporting information?
  • And more…

Download our special report for more on the interdependence of DSH, S-10, and Bad Debts and how they determine whether a hospital will receive its appropriate share of uncompensated care reimbursement.

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Worksheet S-10 has become an increasingly important part of uncompensated care reimbursement. To help us understand more about Worksheet S-10, I’m joined by Jimmy Mendez, who is a Senior Manager on our Reimbursement Services team at BESLER. Jimmy, welcome back to the show.

Jimmy: Thank you, Mike. Good to be here.

Mike: Jimmy, why don’t you start out by explaining why Worksheet S-10 on the Medicare cost report has become so important.

Jimmy: Well, Mike, Worksheet S-10 is critical to any facility that treats a high number of DSH patients. In a facility that has a DSH patient percentage over 15%, it is entitled to a portion of the uncompensated care pool. This uncompensated care pool is a set amount for fiscal year 2020 that CMS allocates to all eligible hospitals. The allocation percentage for each hospital is directly linked to the uncompensated care total reports on Worksheet S-10.

Mike: Jimmy, what are some of the key data files that are needed to get started with the preparation of Worksheet S-10?

Jimmy: Well, these include the following, 835 forms, 837 forms, age trial balance, detailed charges, general ledger, and financial statements, insurance master, transaction code master, hospital service map by patient type, bad debt policies, charity policies, financial assistance policies, patient demographics, charge detail.

Mike: Which ones are the most critical Jimmy?

Jimmy: The most critical are the transactions, which is the patient accounting transaction detail, the charge detail, and the patient demographics. Let’s start with the patient accounting transaction detail. Essentially you want to complete download of the patient accounting system. This will allow you to identify all of the transactions applied to a patient’s account over the life of the patient’s encounter. The payment transactions should be able to reconcile back to the 835 which are remittance advices. And the remittance advice can ID the patient responsibility. Transaction codes identifying primary, secondary, and tertiary pairs, as well as when the hospital started billing the patient, and any charity care discount applied are essential as you want all components of activity beginning with the total charges and ending with the patient’s outstanding balance to include reductions attributable to bad debts. It is also important to identify the service states, financial class, and the GL department number, and GL account number that each transaction hits to ensure that you can reconcile the amounts to the general ledger account.

Mike: You mentioned the charge detail. Can you elaborate on that critical file for us?

Jimmy: Sure. The charge detail is essentially a revenue and usage report that has exploded into transaction level by patient. It will contain data such as patient encounter number, revenue codes, charge amount, unique patient ID, GL department and account, service dates, patient type, patient class, among other items. The total should reconcile to your general ledger. In addition, utilizing the revenue codes, you should be able to identify positions and other professional charges. These should reconcile to your 837 and should be excluded.

Mike: And what information should the patient demographics contain?

Jimmy: This will include patient name, patient account number, unique ID, social security number, address, date of birth, medical record number, Medicare and Medicaid number, collection agency information among various additional information. The importance of the patient demographics is the ability to identify the specific account and ensure that you have all of the correct information tied together from all of your data sources.

Mike: Jimmy, what are some of the issues that may arise that could taint the integrity of the supporting information particularly during an audit?

Jimmy: Well, a big one is not having a well written and defined charity policy that supports the patient detailed transaction charity write-offs. There is a risk that a write-off that is not supported by a charity policy will be deemed an administrative or a courtesy write off and will need to be excluded from Worksheet S-10. Essentially, S-10 should exclude courtesy allowances, discounts to patients not meeting the hospital’s charity care Policy, discounts given to uninsured patients not meeting the hospital’s financial assistance policy that get reimbursed by Medicare, and discounts given to patients for prompt payments. Other activity that needs to be addressed includes zero charge on write-offs, write off amounts that exceeds patient responsibility or charges, and lack of a social security number.

Mike: And as you may have guessed from Jimmy’s comments S-10 can be a bit tricky to prepare. If you’re in a hospital and you need assistance preparing your S-10 or if you’d like us to review the work that you’ve done on your S-10, just drop us a line at There’s also some additional information on our website that you can visit, just head on over to the Reimbursement Services webpage for that. Jimmy Mendez, thanks so much for joining us again today on The Hospital Finance Podcast.

Jimmy: Thank you, Mike.

The Hospital Finance Podcast

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