I'm relatively new to the position of assistant director for a hospital-based dialysis program. I am having trouble determining exactly how we are reimbursed for drugs from Medicare and Medicaid. I know that free-standing facilities are paid according to a fee schedule. I've been told that hospital based systems are not under that system. According to the person who told me this, hospital based providers are reimbursed at cost. The person indicated that we are reimburse throughout the year at a set reimbursement rate; however, when the cost report is done, if we have been overpaid we must repay that amount. Is that correct? If so, how does the fact that some patients don't have a secondary insurance or has a commercial insurance that is secondary tie into this picture. If you can explain this in 20 words or less, I would appreciate it. (Just kidding) I would appreciate any help you can give.

Thanks,

T

Your source is correct in that these items are settled on the cost report, to include allocated overhead costs. Secondary payors are billed and collected directly and do not impact the cost report settlement. If there is no secondary insurance, the patient's payment is made directly, or if this becomes a bad debt, it can be claimed on the cost report assuming the proper protocals are followed for documentation and collections. If you need further information, I can put you in touch with "cost report mechanics" at other hospital-based clients. Just e-mail me at feigal@hdsinfo.com.

Ooooh Medicare Cost reports -

Hi,

If you want to know to what detail your drugs are being reimbursed at, obtain a copy of your dialysis Provider Statistical Reimbursement System - (PS&R is the buzz word) from your Reimbursement Manager or who ever prepares the cost report. These reports are issued quarterly from the intermediary and sent to the provider. You can have the cost report person run you an analysis using this info. and the worksheets in the cost report. If you need further direction- email me.

Kragsac@hotmail.com

Keep in mind that most PS & R reports vary from reality by at least 10%. This has been a concern in the industry for many years.

Cost reports for hospitals are a nightmare at best. It is a major undertaking to try to determine which drugs you were paid for and how much. The NRAA (National Renal Adm. Asso.) is working with CMS to request that hospitals be allowed to bill under their renal provider number and not the hospital provider number. The benefit is that reimbursement checks for your patients come back seperately from the rest of the hospital and therefore makes it easier to track.
If you aren't a member of NRAA, please consider joining. There is a link at the bottom of this web site. Additionally, there is a hospital based committee you could network.