On March 6, 2009, CMS issued Change Request (CR) 6329 (Transmittal 1695) requiring non-teaching hospitals that received Medicare DSH payments in FY 2006 and all inpatient rehab facilities (IRF’s) that received LIP payments in FY 2006 to submit information only claims for Medicare Advantage (MA) patients with discharge dates on or after October 1, 2005 through September 30, 2006 (FY 2006) in order to ensure that DSH calculations for FY 2006 accurately reflect MA inpatient days. These information only claims can be submitted between the implementation date of the CR (July 6, 2009) and November 30, 2009.
The Medicare DSH calculation includes two components, the Medicaid fraction and the SSI fraction. The SSI fraction is determined by comparing the ratio of those days for which a beneficiary was both entitled to Medicare Part A and received SSI payments from the Social Security Administration to total Medicare Part A days. Since by definition, MA patients are entitled to Medicare Part A, the days for which a beneficiary is enrolled, not just paid, in Medicare Advantage should be included in this determination.
This CR requires non-teaching IPPS hospitals that received Medicare DSH payments and all IRF’s that received LIP payments to submit information only bills for the MA beneficiaries they treated in FY 2006. These claims are to be submitted as covered information only claims with Condition Code 04 according to the CR. This CR does not apply to Teaching IPPS hospitals as they should have been submitting MA claims previously with Condition Codes 04 and 69 in order to receive accurate Indirect Medical Education payments.
Prior to CR 6329, CMS issued CR 5647 (Transmittal 1311) dated July 20, 2007, which required non-teaching IPPS hospitals, IRF’s and Long Term Care Hospitals to submit MA claims for periods after October 1, 2006. If you have any questions related to this CR, please contact the experts listed below at (800) 270-9629.
