Hospital cost report modernization April 15, 2015

Agenda Introductions & Meeting Format Updates on the Project Walkthrough: Cost Report Instructions Data Dictionary Submission File/ XML Schema Next Steps

Updates Received and reviewed comments/suggestions Reached out for clarification Incorporated most, if not all, comments Finalized our Draft Cost Report and Instructions Worked with CHIA IT on the Data Dictionary and Submission Requirements

Leverage the CMS-2552-10 Same cost finding methods Same cost (and revenue) centers Same reporting timeframe – 150 Days after FYE Initial Filing would be on March 1, 2016 for 6/30 & 9/30 FYE

Differences from CMS-2552-10 “Full Cost” cost report for analytic purposes Retained cost centers for Medical & Surgical, Pediatric, Obstetric Retained and simplified 403 Schedules deemed necessary Supplemental Information Payer Revenue Allocation to derive IP and OP costs 340B pharmacy

Cost Report Basics Tabs 1-20 Same cost center line/column numbers whenever possible Line 300 series are Subtotals Line 500 series are Totals Color coded the template Other Reimbursable and Special Purpose Cost Centers were grouped with Outpatient

Cost Report Tab 1: Identification and Index New – ECR CMS Submission Number / Preparation Date Tab 2: Summary Schedule of Revenue and Expense Same layout as 403 Deleted the FTEs by cost center Tab 3: Patient Service Statistical Data Deleted admissions and transfers in/out Tab 4: Supplementary Information Similar to 403 New – Reporting for physician assistant and nurse practitioner New – Malpractice Insurance New – Free Standing CHC Simplified Supplementary Revenue

Cost Report Tab 5: Statistical Data and Revenue by Payer Similar to 403 Payer categories are the same New – Report GPSR and NPSR only Deleted – Lines for Deductions and Bad Debt W/Os Tab 6: Gross Patient Service Revenue Collects revenue in the same manner as 403 Include hospital based physicians revenue Updated to 2552 cost centers

Cost Report Tab 9: Direct Expense Same layout as 403 Tab 7: Reclassifications Hospitals can edit to bring costs up to full costs Reclassifications affecting Line 30 Adults and Pediatrics needs to be edited Tab 8: Adjustments Eliminate adjustments for RCE and removing physicians Adjustments affecting Line 30 Adults and Pediatrics needs to be edited

Cost Report Tab 10: Reconciliation to Audited Financial Statements Same layout as 403 Tab 11: Financials Statements Non-Acute hospitals only Same reporting format as Acute Hospitals

Cost Report Tab 13: Statistics for General Cost Step-down Similar to 403 and same as 2552 Statistics affecting Line 30 Adults and Pediatrics needs to be edited Tab 14: Expenses after General Service Costs Stepdown INCLUDING Capital Same layout as 403 Tab 15: Expenses after General Service Costs Stepdown EXCLUDING Capital

Cost Report Tab 16: Statistic using GPSR for Ancillary Service Costs Allocation New - Uses GPSR as the statistic for allocation No entry on line for Observation Beds Cost /Non Distinct Unit Tab 17: Allocation of Ancillary Expenses to IP & OP Routine Cost Centers INCLUDING CAPITAL Same layout as 403 Tab 18: Allocation of Ancillary Expenses to IP & OP Routine Cost Centers EXCLUDING CAPITAL Tab 12: Allocation of Observation Beds Cost to a Non Distinct Units Same manner as 403 New – Report only observation bed day equivalents

Cost Report Tab 19: Pharmacy Schedule Hospitals with a 340B Pharmacy only Same layout as 403 Tab 20: Provider Based Physician Adjustment Same layout as 2552 Will substitute for the 403’s Schedule XXV

Data Dictionary Explains the identity of each cell that in the Cost Report Each column displays the attributes of each cell Cell Identifier – Unique code for each cell Tab# – Which Tab the cell can be found Cell Identifier Tab# Line#/Vertical Column#/Horizontal Cross reference Name SubScript? Input Type Length Usage Description 01.00.001.00.001 1 Hospital N Text 64 X Enter Hospital Name 01.00.002.00.001 2 Reporting Year Numeric 4 9 Enter the reporting year that is being documented 01.00.003.00.001 3 Address Enter the Hospital's Address 01.00.004.00.001 Filer Name 35 Enter the name of the person responsible for filing

Data Dictionary Line# – The Line number that the cell can be found Column# – The Column number that the cell can be found Cross Reference Name – Identifies the Line Name and the Column Name for each field listed Subscript? – Determines if the entire Line can be subscripted with the Tab

Data Dictionary Input: “Hospital” – Hospital data required “Calculated” – Calculated value “Linked” – Value will match another field found within this Cost Report “CMS” – Value will match a field in the CMS 2552-10 Cost Report If Blank, data is not required

Data Dictionary Type: “Numeric” – Value is a Number “Text” – Value is an Alpha-Numeric Blank – Value not required

Data Dictionary Length – Max length for value Usage – Follows CMS defined format Description – Any additional information to find value for cell, such as formulas or location of linked value

Submission File XML submitted through INET One file per hospital

Submission File – Basic Example

Submission File – Modifiers Tag Use <RowName></RowName> Alters or adds name to row or sub row. <HCRIS></HCRIS> Add HCRIS to given row. <ColumnName></ColumnName> Alters or adds column name. <SubColumnName Name =""></SubColumnName> Only used on Tab 13 to add allocation method text. <SubColumn></SubColumn> Indicates the following tags are part of a sub column connected to parent. <SubRow></SubRow> Indicates the following tags are part of a sub row connected to parent.

Submission File – Example with Modifiers

Breakdown by Data Entry Hospital input 2,627 Transferred from CMS-2552-10 Report 2,712 Calculations 7,819 Cells Linked within the Report 2,384 No Action Required Cells 1,485 Total Data Cells 17,027 15%

Next Steps If you have questions or comments, please respond by April 29th to CHIA.data@state.ma.us CHIA will review all comments received and communicate decisions. CHIA IT will communicate the plan for submitting test files. Updates will be on our Hospital TAG webpage. Contacts: mary.byrnes@state.ma.us (617) 701-8180 annemarie.martel@state.ma.us (617) 701-8109