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S-10 101 [PODCAST]

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The Hospital Finance Podcast

In this episode, we welcome back Christina Brown, Reimbursement Manager at BESLER, to talk about Worksheet S-10 as part of our Reimbursement 101 series.

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Highlights of this episode include:

  • What makes Worksheet S-10 an important component of the Medicare Cost Report
  • What type of data is on Worksheet S-10
  • What data is needed to process the various sections of S-10
  • Best practices
  • Standard format for the bad debt and charity listings

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance podcast. Today we’re going to be talking about Worksheet S-10 as part of our Reimbursement 101 series. And to walk us through that, I’m joined by Christina Brown, who is a Reimbursement Manager on our reimbursement services team here at BESLER. Christina, welcome back to the show.

Christina Brown: Hi. Thanks, Mike. Glad to be back.

Mike: So, Christina, what makes Worksheet S-10 an important component of the Medicare cost report these days?

Christina: That’s a good question. So the Worksheet S-10 has become increasingly more important over the past several years. And for hospitals that receive disproportionate share reimbursement, the uncompensated care section is of particular importance, as it is one of the three factors that determine the amount of uncompensated care payments that providers will receive.

Mike: Yes. It’s certainly come on in the past few years. Let’s dig into some of the details, Christina. What type of data is on Worksheet S-10?

Christina: Sure. Yeah. So the Worksheet S-10 is essentially grouped into a few sections, and the first line has the cost-to-charge ratio, and that is used in various calculations throughout the worksheet. And after that, there is a section for reporting Medicaid reimbursement, followed by sections to report children’s health insurance program and other state or local government indigent care program reimbursement. However, as I said before, the main area of importance is that last section, and that is the uncompensated care section. And it is the primary focus of what we all discuss when we’re talking about Worksheet S-10.

Mike: Christina, what data is needed to process the various sections of S-10?

Christina: Sure. So the cost-to-charge ratio, as I mentioned first previously, that is derived from Worksheet C. And the subsequent sections – Medicaid, CHIP, and other program reimbursement – that could be derived from the internal records. And the instructions are pretty clear on each of those lines what’s to be reported. But the last section, however, the uncompensated care section, it is a bit more involved as it requires processing of full transaction detail for all patients that are written off to charity and bad debt during the cost-reporting period.

Mike: Okay. And I know you work on S-10 quite a bit. Do you have some best practice suggestions for the audience?

Christina: Sure. I certainly do. 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 codes that are mapped. So it’s important to be able to reconcile the bad debt and the charity write-off to the financial statement or at least understand why it doesn’t reconcile. Beyond those, very basic things. As the transaction detail is being processed, it is important to review the transaction detailed data for any potential audit risks. And these could be things such as, but you’re not limited to, ensuring that all the 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 the reported charges and that the lifetime balances for each of the populations makes sense. Like if your patient payments or your insurance payments or debits– that the total lifetime amounts of those are debits. And just basic things like that. And we also make sure that the account balance for each record also makes sense for the detail reported. And that basically just means that we can come back to the account balance based upon the transaction detail that we are reporting.

Mike: Is there a standard format to submit for the bad debt and charity listings?

Christina: Yeah. Actually, in the proposed Transmittal 17, there were exhibits released, but subsequently, whenever it was finalized, those exhibits were actually removed. And while there is no standard format at this time, it really is a good idea to review those exhibits to ensure that there is a way to obtain all the detail and data reflected on those exhibits. And while those exhibits did have some issues, we do anticipate that some version of those will be released in the future. But essentially, for now, we’re just using the formats that are requested during the audits.

Mike: Excellent. And obviously, we’re just scratching the surface here of S-10. Christina has recorded a webinar on this topic which goes into much more detail. And if you’d like to watch a recording of that webinar, just go up to, click on the insights button, and look for the reimbursement tab, and you will find that there along with a host of other resources. Christina Brown, thanks so much for joining us today on the podcast.

Christina: Thank you very much. It was my pleasure.

[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit The Hospital Finance Podcast is a production of BESLER, SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.

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