What is CMS SSI?
The Center for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register on August 18, 2011 that includes surgical site infection (SSI) reporting via the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) in the CMS Hospital Inpatient Quality …
What is the SSI ratio?
The SSI ratio, also known as the Medicare fraction, represents the percentage of patient days for beneficiaries who are eligible for both Medicare Part A and SSI. Because SSI days reside in the numerator of the Medicare fraction – the greater number of SSI days, the greater the DSH payment.
How would a hospital go about qualifying as a DSH?
The primary method applies to hospitals serving a significantly disproportionate number of low-income patients, based on the hospital’s Disproportionate Patient Percentage (DPP). If a hospital’s DPP equals or exceeds a specified threshold amount, the hospital qualifies for the Medicare DSH adjustment.
How do you calculate DSH?
Because Hospital A is located in an urban area, has less than 100 beds, and has a DSH patient percentage of more than 20.2%, the formula for determining the Medicare DSH adjustment is: 5.88% + [. 825 x (DSH % – 20.2%)]. Urban hospitals with less than 100 beds are subject to a maximum DSH adjustment of 12%.
What is capital DSH?
known as the capital disproportionate share hospital (DSH) payment, for hospitals that are. known as the capital disproportionate share hospital (DSH) payment, for hospitals that are. classified as urban and have 100 or more beds.
What is a DSH payment?
Provider Payment. Medicaid disproportionate share hospital (DSH) payments are statutorily required payments intended to offset hospitals’ uncompensated care costs to improve access for Medicaid and uninsured patients as well as the financial stability of safety-net hospitals.
What is DSH?
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What defines a critical access hospital?
Critical Access Hospital is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS). The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities.
What is a 340B hospital?
The federal 340B Program is a drug price control program that allows qualifying providers, generally hospitals, specialty clinics and their associated outpatient facilities serving uninsured and low-income patients in rural communities, to purchase outpatient drugs from manufacturers at discounted prices.
What is a DSH facility?
What are DRG payments?
A diagnosis-related group (DRG) is a patient classification system that standardizes prospective payment to hospitals and encourages cost containment initiatives. In general, a DRG payment covers all charges associated with an inpatient stay from the time of admission to discharge.
How are SSI ratios calculated for Medicare DSH?
Revised SSI ratios for the Medicare DSH calculation for FY 2006 through FY 2009 are available at the hyperlinks below. In addition to including MA patient days in the ratios for FY 2006, 2007, 2008, and 2009 CMS has also calculated the SSI ratios in the manner proscribed by CMS-1498-R.
How is the SSI ratio calculated for an IRF?
The SSI data file below shows the latest available IRF-specific data to compute an IRF’s SSI ratio for the specified fiscal year (FY). An IRF may use this ratio as part of the formula to estimate their adjustment for low income patients (LIP) for a cost reporting period that begins subsequent to that specified FY.
When to include Ma patient days in SSI ratios?
In addition to including MA patient days in the ratios for FY 2006, 2007, 2008, and 2009 CMS has also calculated the SSI ratios in the manner proscribed by CMS-1498-R. To view these ratios, please visit the link below in the downloads section.
How does Medicare calculate disproportionate share of hospital?
Under the primary method to qualify for DSH adjustments, the first computation includes the number of hospital patient days used by patients who, for those days, were entitled to both Medicare Part A and SSI (excluding State supplementation).