CMS Mandates Non-Teaching Hospitals Submit FY 07 and 08 Informational-Only Medicare Advantage Claims And Attestation That All Such Claims Have Been Submitted
On May 5, 2010, CMS issued a One-Time Notification (OTN) to Medicare Administrative Contractors (MACs) and Fiscal Intermediaries (FIs) requiring certain inpatient prospective payment (IPPS), inpatient rehabilitation facility (IRF), and long term care (LTC) hospitals to submit, no later than August 31, 2010, all or additional informational-only Medicare Advantage (MA) claims for fiscal years (FYs) 2007 and 2008. The OTN further requires that these providers submit a signed attestation, no later than September 15, 2010, that all such informational-only MA claims, if any, have been submitted.Failure to comply with these mandates may result in CMS instructing the MAC/FI to use an SSI ratio of 0 percent to calculate Medicare disproportionate share hospital (DSH) and low income patient (LIP) payments or to take other action that may affect payments. CMS issued the OTN in response to a finding that many hospitals have not reported any MA days pursuant to Change Request 5647, Transmittal 1311, dated July 21, 2007. The OTN, effective July 7, 2010, can be found at http://www.cms.gov/transmittals/downloads/R696OTN.pdf. The OTN should be read in conjunction with CMS Ruling 1498-R, issued April 28, 2010, which requires recalculation of the Medicare DSH payment percentage for all open cost reports and jurisdictionally proper Provider Reimbursement Review Board appeals involving noncovered Medicare Part A days, labor and delivery days, and the data matching process used to calculate the SSI fraction.

The OTN applies only to the following types of providers:

• Non-teaching IPPS hospitals that include an operating and/or capital DSH payment amount on their Medicare cost report that uses the FY 2007 or FY 2008 SSI ratio, or hospitals that believe they will qualify for such a payment by submitting MA claims. The OTN defines “non-teaching IPPS hospitals” as hospitals that do not train residents in approved residency programs or operate nursing and allied health (N&AH) education programs, and do not qualify to receive direct or indirect medical education (DGME and IME, respectively) payments, or N&AH payments.


• IRFs that were not required to submit any MA claims in accordance with the Medicare Processing Manual (MPM), Pub. 100-04, Ch. 3, § 20.8, for the purpose of receiving DGME or N&AH payments. IRFs that do not claim LIP payment on their Medicare cost reports are exempt unless they believe they will qualify for such payments by submitting MA claims.


• LTC hospitals that were not required to submit any MA claims in accordance with MPM, Pub. 100-04, Ch. 3, § 20.8, for the purpose of receiving DGME or N&AH payments.

The OTN contains a copy of the attestation form, which must be submitted on hospital letterhead and signed by a Senior Hospital Official or Administrator. Each provider must submit separate attestations for FY 2007 and 2008, and each attestation may also include a list of provider numbers for any applicable distinct part units. According to the OTN, CMS expects to post FY 2007 revised ratios and FY 2008 ratios by the first quarter of 2011.

If you have any questions regarding this Client Alert, please contact Sandy Pitler, Kelly Thomas, or Jill Scott at 206-622-5511.