MEDICARE DISPROPORTIONATE PATIENT PERCENTAGE
Medicaid Day Fraction
Medicaid Eligible Days –
In calculating the number of Medicaid days, the
hospital must determine whether the patient was
eligible for Medicaid under a State plan
approved under Title XIX on the day of service.
If the patient was eligible, the day is
in the Medicare DSH adjustment calculation.
Medicaid days, for
purposes of the Medicare DSH adjustment
calculation, include all days during which a
patient is eligible, under a State program
approved under Title XIX, for Medicaid benefits
even if Medicaid did not make payments (e.g.
Unpaid Patient Days) for any services.
The usual day components
reported by the hospital are the following:
However, Medicaid days
also include, but
are not limited to:
Medicare Day Fraction
The Medicare fraction is
computed by dividing the number of patient days
for patients who were entitled to both Medicare
Part A benefits and SSI benefits by the total number of patient
days for patients entitled to benefits under
Medicare Part A.
Our services include
a full analysis of the Medicare fraction and
related SSI percentage components. This analysis
would include the audit, verification, and
identification of total patient days with both SSI and Medicare Part A coverage (the fraction
numerator) and Total Medicare Days (the fraction
In order to calculate the
numerator of the Medicare fraction, HCS obtains
a data file from CMS which is based on
information obtained from the Social Security
Administration (SSA) that includes a list of
eligible SSI recipients. HCS then matches
information from this CMS’s SSI file against
CMS’s Medicare Part A entitlement information
contained in the Medicare Provider Analysis and
Review (MEDPAR) file to determine the number of
Medicare/SSI days for a particular hospital in a
particular federal fiscal year. The fraction
denominator of the fraction is calculated by CMS
based on Medicare claims data.
Examples of Medicare/SSI
days include but are not limited to the following
patient day components:
Hospital Database Analysis
In order to fully account
for all hospital DSH patient day information, a
number of large databases will have to be
analyzed, comparatively matched with other
hospital database information sources, and
interfaced with a number of governmental
databases for Medicare, Medicaid and Social
Security Administration information.
HCS has developed a number of
computer-based programs which are used to
integrate the numerous sources of hospital and
government information and patient databases.
Programs Included the following:
GME and IME