1. HOSPITAL COST REPORT MODERNIZATION April 15, 2015

2. Introductions & Meeting Format Updates on the Project Walkthrough: 1.Cost Report 2.Instructions 3.Data Dictionary 4.Submission File/ XML Schema Next Steps Agenda 2

3. 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 Updates 3

4. 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 Leverage the CMS-2552-10 4

5. Differences from CMS-2552-10 5 “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

6. Cost Report Basics 6 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

7. 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 Same layout as 403 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 7

8. 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 8

9. 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 Hospitals can edit to bring costs up to full costs Eliminate adjustments for RCE and removing physicians Adjustments affecting Line 30 Adults and Pediatrics needs to be edited Cost Report 9

10. 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 10

11. 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 Same layout as 403 Cost Report 11

12. 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 Same layout as 403 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 12

13. 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 Cost Report 13

14. 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 Data Dictionary 14 Cell Identifier Tab #Line#/Vertical Column#/H orizontalCross reference NameSubScript?InputTypeLengthUsageDescription 01.00.001.00.001111HospitalN Text64XEnter Hospital Name 01.00.002.00.001121Reporting YearNHospitalNumeric49Enter the reporting year that is being documented 01.00.003.00.001131AddressNHospitalText64XEnter the Hospital's Address 01.00.004.00.001141Filer NameNHospitalText35X Enter the name of the person responsible for filing

15. 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 15

16. 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 16

17. Type: “Numeric” – Value is a Number “Text” – Value is an Alpha-Numeric Blank – Value not required Data Dictionary 17

18. 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 Data Dictionary 18

19. XML submitted through INET One file per hospital Submission File 19

20. 20 Submission File – Basic Example

21. 21 Submission File – Modifiers TagUse Alters or adds name to row or sub row. Add HCRIS to given row. Alters or adds column name. Only used on Tab 13 to add allocation method text. Indicates the following tags are part of a sub column connected to parent. Indicates the following tags are part of a sub row connected to parent.

22. Submission File – Example with Modifiers 22

23. Breakdown by Data Entry 23 DATAHospital input2,627 DATATransferred from CMS-2552-10 Report2,712 DATACalculations7,819 DATACells Linked within the Report2,384 DATANo Action Required Cells1,485 DATATotal Data Cells17,027 15%

24. Next Steps 24 If you have questions or comments, please respond by April 29 th to CHIA.data@state.ma.us 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 mary.byrnes@state.ma.us  annemarie.martel@state.ma.us (617) 701-8109 annemarie.martel@state.ma.us