In this episode, we’re pleased to welcome back Christina Brown, BESLER’s Director of Reimbursement Services, to give us a glimpse into BESLER’s next Webinar: Reimbursement Best Practices Series – S-10.Learn how to listen to The Hospital Finance Podcast® on your mobile device.
Highlights of this episode include:
- S-10 and its importance
- What’s reported on Worksheet S-10
- Data that is needed
- Best practices
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Christina Brown, BESLER’s Director of Reimbursement Services. In this episode, Christina will give us a glimpse into BESLER’s next webinar in our Reimbursement Best Practices Series, reviewing S-10, that we’re hosting on Wednesday, October 11th at 1 PM Eastern Time. Welcome back and thank you for joining us, Christina, for our 400th podcast episode.
Christina Brown: Wow, yes, thank you so much. I appreciate you having me on here again.
Kelly: Yes, definitely. Well, let’s go ahead and jump in. Can you give us a brief summary about S-10 and its importance?
Christina: Oh, sure. So, S-10 is simply a worksheet that is on the Medicare Cost Report. It’s part of the S series. So, this worksheet acts as a main source to report a hospital’s uncompensated care. Now, this worksheet hasn’t always carried the significance that it does today. Actually, before 2018, Worksheet S-10 was simply used for reporting, and therefore, instructions were actually somewhat vague, to be honest. But since 2018, there has actually been a great deal of evolution in the use of instructions for S10, and it is really most significant for those providers that qualify as a disproportionate share hospital, since the total uncompensated care that is calculated on the worksheet is used to determine the factor three in the equation of what the hospital actually receives for their disproportionate share payment.
Kelly: Great, thank you. And can you please elaborate on what is reported on Worksheet S-10?
Christina: Sure, so the worksheet is essentially grouped into a few sections. Now, the first line is the cost-to-charge ratio, and that’s pulled in from the cost report, so it’s an auto flow. And after that, there is a section that you report your Medicaid reimbursement, followed by sections that report the Children’s Health Insurance Program (CHIP) and other state and local indigent care program reimbursements. And those will typically come from the hospital’s internal records. Now, however, the main area of importance is the last section, and that is the uncompensated care section. And it is the primary focus of what we’re going to be discussing in the webinar. And this is an area that reports the charity and bad debt amounts claimed by the provider.
Kelly: That’s a lot of information. Seems complicated. Will you discuss the data that is needed?
Christina: Yes, I actually will. So we’re actually going to spend a great deal of time in the webinar discussing the data and how to report it on Worksheet S-10. In summary, for the top section of the cost-to-charge ratio, as I mentioned before, it’s mainly derived from Worksheet C and from Worksheet A just to get that cost-to-charge ratio. And the Medicaid and CHIP and the other program reimbursement, as I said, that comes from probably the hospital’s internal records as there’s probably not really a way to drive that in automatically. So, in the uncompensated care section, that is actually a bit more involved as it requires processing of full transaction detail for all patients written off to charity and bad debt during the cost reporting period.
Kelly: Fantastic. Regarding the charity and bad debt sections, it sounds like there is a deeper dive required. Will you be going into that during the upcoming webinar?
Christina: Absolutely, and that is actually going to take up a large portion of the webinar. As some are likely aware, CMS released final versions of the exhibits for charity and bad debt, and I’ll be going over those exhibits in detail, as well as best practices for processing that data.
Kelly: That’s great. Can you provide a little preview as to what kinds of things you’ll be outlining for best practices?
Christina: Sure, I’d be happy to do that. So first, it is important to have clearly defined charity and bad debt policies, as well as an understanding of how those policies are being followed and how that relates to the transaction code mapping that you have in your patient accounting system. So, it’s important to be able to reconcile the bad debt and the charity write-offs to the financial statement or understand why it doesn’t reconcile because as you know, that’s one of the first things that the auditors ask for. So, you really need to have that understanding. Beyond those basics, as the transaction detail is being processed, it is also important to review the transaction detail data for any potential audit risks. These would be things such as, but not limited to, ensuring that all pertinent fields contain data and that if a physician or professional fees exist, that the amount has been reported and the write-off has been adjusted if necessary. We also review for things like ensuring the write-offs do not exceed reported charges and that lifetime balances for each population make sense, and that the account balance for each record also makes sense for the detail that’s being reported on those exhibits.
Kelly: Thanks. We all love best practices. I know we have covered the S-10 topic in the past. Can you tell us if there will be anything new covered during this webinar?
Christina: That’s another great question, Kelly. Yes. We will definitely be covering some new information. As the exhibits, they were just finalized this year. There’s also another part to S-10 that was added in Transmittal 18. So previously, there was only one worksheet for S-10, but effective for cost reports beginning on or after 10/01/2022, there is now a part one and a part two that will need to be completed on the 2552-10. So, while the parts are identical, the worksheets are identical that you’re looking at in the parts, the data that gets reported will actually be different. Basically, one is for the hospital and while the other is for the full complex. So, as I stated before, the new information that I’ll be covering will be basically what those parts are and how to report those, what to report on those different parts, as well as those exhibits and what kind of information needs to go on those and how to process that new information that’s being requested by CMS.
Kelly: Sounds great. Looking forward to that. Thank you so much for joining us, Christina, and for sharing this sneak peek into BESLER’s upcoming webinar, the next in our Reimbursement Best Practices Series on S-10 that we’re presenting live on October 11th. And as a bonus, you can earn CPE. Thanks again, Christina.
Christina: Thank you so much. I’m looking forward to it.
Kelly: Me too. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
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