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Update Opportunity for Medicare Advantage Patient Information Needed for

Medicare Disproportionate Share (DSH) Payments for

Fiscal Years (FY) 2007 and 2008



CMS Referenced: Pub 100-20 one time notification transmittal 696 OTN Change Request: 6821

Date: May 5,2010

In the above referenced transmittal, the Centers for Medicare and Medicaid Services (CMS) issued notification which requires non-teaching hospitals to submit informational only bills for the Medicare Advantage (MA) beneficiaries they treated in FY 2007 and FY 2008.

Updated/revised MA inpatient days reported on the informational only claims are needed to calculate the number of inpatients eligible for Medicare who are receiving Supplemental Security Income (SSI), which is used to accurately determine the Medicare Disproportionate Share (DSH) payments.

The providers affected; applies to all hospitals paid under the inpatient Prospective Payment System (PPS), inpatient rehabilitation facilities under PPS and long term care hospitals under PPS.

Based on changes in CMS positions and information elements pertaining to DSH providers, it has become apparent that a number of providers, particularly non-teaching hospitals, have not been providing this information for their Medicare Advantage patients.

Based on the latter factors, previously computed SSI ratios could be understated and/or inaccurate, which would have a major impact on Medicare DSH reimbursement. Therefore, CMS is allowing providers a one-time opportunity to revise Medicare Advantage (MA) claims information for FY 2007 and FY 2008.

However, all such claims information must be submitted to the respective Medicare Administrative Contractor (MAC) and Fiscal Intermediary (FI) no later than August 31, 2010.

In addition, providers must attest to their Medicare contractors that they have either submitted all of their Medicare Advantage claims for FY 2007 and FY 2008 or that they have no Medicare Advantage claims for those years. Providers are required to submit an attestation to their MAC on or before September 15, 2010.

Providers have an incentive to carefully review all MA inpatient records for FY 2007 and FY 2008, so that they can comply with the stated deadlines. This requirement applies to all providers paid under the inpatient Prospective Payment System (PPS), inpatient rehabilitation facility PPS and long-term care hospital PPS. The inpatient days reported on the referenced 'inpatient informational only claims' are needed to the Supplemental Security Income (SSI) ratio for fiscal years 2007 and beyond to reflect Medicare DSH payments and Low-Income Payments (LIP) under rehab PPS.

It should be noted that if a provider does not submit all of its informational only Medicare Advantage claims (FY 2007 and FY 2008), and attestations that all MA claims for the two years have been submitted or that it does not have any MA claims for these fiscal years, CMS may instruct the Medicare Contractor to use a SSI ratio of zero percent (0%) to calculate the Medicare DSH payments or take other actions that may affect payment for non-compliant providers.

A Medicare provider will be in non-compliance with the instructions in CR 6821, if it does not submit all of its:


  • Informational only Medicare Advantage claims for FY 2007 and FY 2008 and

  • Attestations that all of its Medicare Advantage claims for FY 2007 and FY 2008 have been submitted or that it does not have any Medicare Advantage claims for these years.


    Applicable non-teaching IPPS hospitals, IRF's and LTC hospitals have until August 31, 2010 to submit FY 2007 and FY 2008 Medicare Advantage informational only claims (111 Bill Type with Condition Cod 04), Medicare Contractors have been instructed to override timely filing for claims submitted in accordance with CR 6821.

  • Link References

    CMS - Transmittal 696
    Attestation Statement (sample)
    MLN Matters Number: MM6821
    MLN Matters Number: MM5647