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DSH adjustment controversies continue.

Christopher L Keough1

  • 1Powers Pyle Sutter & Verville PC, Washington, D.C., USA. ckeough@ppsv.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|March 27, 2003
PubMed
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Medicare intermediaries are adjusting disproportionate share hospital (DSH) payments by excluding certain patient days. Hospitals should understand these changes and appeal questionable adjustments to protect DSH reimbursement.

Area of Science:

  • Healthcare Policy
  • Hospital Financial Management
  • Medicare Regulations

Background:

  • Medicare intermediaries are altering Disproportionate Share Hospital (DSH) payment calculations.
  • These adjustments involve the exclusion of specific patient days from the DSH formula.
  • The validity of these intermediary adjustments is legally questionable.

Purpose of the Study:

  • To analyze the impact of intermediary adjustments on DSH payments.
  • To inform hospitals about changes in DSH calculation methodologies.
  • To advise hospitals on protecting their financial interests regarding DSH reimbursement.

Main Methods:

  • Review of Medicare intermediary practices in DSH payment calculations.
  • Analysis of exclusions related to labor/delivery room days.

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  • Examination of exclusions for dual-eligible patient days and Medicaid-eligible days not covered by Medicare Part A.

    • Main Results:

    • Intermediaries are excluding labor/delivery room days for maternity patients unless they occupied a routine bed.
    • Medicaid-eligible days for patients not entitled to Medicare Part A are also excluded.
    • These exclusions reduce the calculated DSH payment for affected hospitals.

    Conclusions:

    • The current DSH payment adjustments by Medicare intermediaries raise legal concerns.
    • Hospitals are encouraged to scrutinize these adjustments.
    • Hospitals should actively protect their right to appeal DSH payment reductions.