Medicare Disproportionate Share Payments

The Medicare Disproportionate Share Payments remain one of the few areas in Prospective Payment Reimbursement where a detailed concentration of review can benefit the hospital through a direct increase in cost report settlement. Our firm performs the following steps:

  • Verify Medicaid eligible days
  • Verify out of state eligible days
  • Ensure that eligible days relate to PPS services
  • Ensure that observation days are appropriately accounted for
  • Review of the Supplemental Security Index (SSI) ratio
  • Determine the advantage or disadvantage of a recalculation of the SSI ratio on the basis of a non-governmental fiscal year-end
  • Determine DSH opportunity for rehabilitation units (IRF)
  • Use the above steps to appropriately document and claim Rehab DSH, which is called low-income patient payment or LIP
  • Provide support through the audit process with your fiscal intermediary

Fiscal Intermediaries continue to place more stringent audit guidelines on the detailed review of the disproportionate share payment calculations, and likewise, hospitals should continue to place a greater emphasis on ensuring accuracy in reporting in this area to receive a complete and accurate amount of payments allowed under Medicare regulations.

Doctors Walking Together

Together, we can discover the solutions your organization needs.