South Carolina Hospital Association HITECH Stimulus Calculator These worksheets have been forwarded to South Carolina hospital CFOs. They provide hospital-

South Carolina Hospital Association

HITECH Stimulus Calculator

These worksheets have been forwarded to South Carolina hospital CFOs. They provide hospital-

specific estimations of ARRA HITECH for your facility based on the latest CMS HCRIS data.

Federal Register Volume 75, Number 8Wednesday, January 13,

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 422, and 495,

Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Sec. 495.104 Incentive payments to eligible hospitals, Page 1997.

http://www.gpo.gov/fdsys/pkg/FR-2010-01-13/html/E9-31217.htm


Sec. 495.104 Incentive payments to eligible hospitals (Page 1997)

(a)General rule. A qualifying hospital (as defined in this subpart) shall receive the special incentive payment as determined under the formulas described in paragraph (c) of this section for the period specified in paragraph (b) of this section. – A “qualifying hospital” is primarily determined by meeting Meaningful Use

Criteria as defined beginning on page 1849– The Meaningful Use definition is complicated and will be difficult to meet– This definition is being challenged by the American Hospital Association

and most state associations– This report focuses only on the financial impact of the incentive payments

once eligibility has been met.



Hospitals paid under the Prospective Payment System

• Hospitals whose first payment year is FY 2011 may receive such payments for FYs 2011 through 2014



• Hospitals whose first payment year is FY 2014 may receive such payments for FY 2014 through 2016

• Hospitals whose first payment year is FY 2015 may receive such payments for FY 2015 through 2017.



PPS Hospitals will receive a Medicare percentage and a Medicaid

percentage of an initial amount equal to one of the following:• For each hospital with 1,149 discharges or fewer during the fiscal year prior to

the payment year, $2,000,000. • For each hospital with at least 1,150 discharges during the payment year will

receive the base incentive amount of $2,000,000 plus an additional $200 for every discharge between 1149 and 23,000 (21,851 discharges)


PPS Examples:

1) For a hospital with 1,000 discharges the initial amount is only the base amount of $2,000,000

2) For a hospital with 10,000 discharges the initial amount is calculated as follows:

$2,000,000 + ((10,000 – 1149) * $200)) = $3,770,200

3) For a hospital with 23,000 discharges the initial amount is calculated as follows:

$2,000,000 + ((23,000 – 1149) * $200)) = $6,370,200

4) For a hospital with 25,000 (greater than 23,000) discharges the initial amount is calculated as follows:

$2,000,000 + ((23,000 – 1149) * $200)) = $6,370,200


The Report

Your hospital’s Chief Financial Officer has received an estimation of you hospital’s potential receipts based on historical CMS data

These PowerPoints are samples for point reference only. Follow along on your actual copies.


PPS Providers

Medicaid

The report for PPS hospitals includes 2 pages: •Page 1, Medicare estimations•Page 2, Medicaid and Consolidated estimations

Combined total

Medicare

Medicare

Total Available Funds

Hospitals do not automatically receive the entire base incentive payment. This section calculates the total base. Actual distributions

are based on a Medicare and Medicaid Percentage of the overall facility total.

Medicare

Your hospital-specific data was obtained from the latest HCRIS data available from CMS. The Cost

Report period is noted above.

Medicare

All variable historical data fields are highlighted and can be updated to allow you to enter more recent Cost Report data or to allow you enter estimations

in order to review their impact.

Medicare

The initial amount consists of a flat $2,000,000 for every facility.

An additional $200.00 is also available for every discharge between 1,150 and 23,000 or a maximum amount of 21,851 discharges

In this example:Qualified Discharges: 23,000 – 1,149 = 21,851

Per Discharge Rate: 21,851 x $200 = $4,370,000

The two amounts combined equal the total initial amount$2,000,000 + $4,370,000=$6,370,000

Only a portion of this amount is available to hospitals; a Medicare percentage and a Medicaid percentage.

The Medicare Percentage

Total Medicare and Medicare Advantage Days as a percent of total hospital days

Adjusted by a Medicare charity care ratio.

As charity increases, the Medicare share also increases.

Note: This is a variable field which will allow you to input your hospital’s charity dollars to adjust

this estimation.

The Medicare Percentage

Year 1 pays 100% of the Medicare maximum incentive payment

Years 2-4 pay a declining percentage of the Medicare maximum incentive payment

The Medicaid Percentage

The annual distribution has not yet been defined for the Medicaid portion, however the

declining percentages apply to the total allowable amount. Therefore, the Medicaid percentage is applied to the total available

over the 4 year period.


The Medicaid percentage is the hospitals traditional Medicaid days plus Medicaid managed care days as a percent of total

hospital days.

Adjusted by the same charity care ratio used in the Medicare percentage.


The 4 year total simply applies the Medicaid percentage to the total allowable amount.


Based on SCDHHS’ current intentions, this box distributes Medicaid funds on the same 4 year allocations as Medicare and produces a

4 year total Medicare and Medicaid reimbursement.

Sec. 495.106 Incentive payments to CAHs (Page 1997)

Critical Access Hospitals

• CAHs are subject to the same eligiblity requirements as PPS hospitals (meaningful use criteria)

• A qualifying CAH receives an incentive payment amount equal to its reasonable costs incurred for the purchase of certified EHR technology times the Medicare share percentage plus an additional 20 percentage points, not to exceed 100% of costs.

Total EHR Costs X (Medicare Share + 20% )

• There is no additional payment component to CAHs for a Medicaid share


Critical Access Hospitals

The Critical Access Hospitals report consist of a Medicare Form Only

As CAH payments are actual cost-based, no data is available for estimating these cost, This form completes the data fields available

from HCRIS data and allows the user to input cost estimations.

MedicareThe Medicare Percentage

Total Medicare and Medicare Advantage Days as a percent of total hospital days

Adjusted by a Medicare charity care ratio.

An additional 20 percentage points (not to exceed 100%)

Medicare

Each years actual costs Each years actual costs

times the Medicare Percentage

Each years actual costs

times the Medicare Percentage

equals

each years stimulus payment


HITECH Stimulus Calculator

Contact:

Barney Osborne, VP of Finance and Reimbursement


803.744.3544

[email protected]

Documents

South Carolina Hospital Association HITECH Stimulus Calculator These worksheets have been forwarded to South Carolina hospital CFOs. They provide hospital-