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Understanding the Data
Faith Asper, MHS
Director, ResDAC Assistance Desk
Objectives
Understand how the processing impacts the data
Recognize key issues
Understand options to deal with issues
2
Annual Filing Requirements
Annual filing of 12 months or 13 four-week periods
May submit partial year reports or partial cost report, under certain circumstances
˗ Change in provider’s fiscal year
˗ Change in provider ownership status
˗ Low or no Medicare utilization
˗ Initiate or terminate with the Medicare program
» Includes change from acute hospital to Long Term Care Hospital or Critical Access Hospital
Implication is that multiple cost reports per provider per year exist.
3
Providers with Multiple Cost Reports by Year
FFY 2007 FFY 2008 FFY 2009 FFY 2010 FFY 2011 FFY 2012
> 1 Cost Rpt 91 102 95 47 41 0
1 Cost Rpt 5995 5991 6005 6040 5903 846
97%
98%
98%
99%
99%
100%
100%
Pe
rce
nt
4
Providers with Multiple Cost Reports
81%
14%
5%
Federal Fiscal Year 2011
Fiscal Year Change
Ownership Change
Initial/Last Cost Report
Reasons for Multiple Cost Reports
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Multiple Cost Reports
Fiscal year changes: ˗ Use all cost reports provided to come up with an overall
average
˗ Use the cost report that represents the majority of the fiscal year
Ownership change: ˗ Need to keep the cost reports separate because the change
in ownership could change how information is reported in the cost reports
Low or no Medicare utilization ˗ No information will be available for these facilities
Initiate or terminate with Medicare ˗ Use the information that is available
Options for handling multiple cost reports
6
Quarterly Updates to Data Files
CMS overwrites the cost report data in HCRIS each
quarter with the highest status cost report.
Changes in status codes indicate changes to the data
files.
It is not easy to identify the changes with each
download.
7
Cost Report Status Codes
The order of the status codes is (lowest to highest):
˗ As Submitted
˗ Settled without Audit
˗ Settled with Audit
˗ Reopened
˗ Amended
8
Status Codes by Fiscal Year
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012
Amended
Reopened
Settled with Audit
Settled without Audit
As Submitted
Fiscal Years 2007-2011, March 2013 download
9
Changes to the Data Files
Depending on your study, researchers may need to
˗ Download a point in time cost report data set and work
with that set for the project
˗ Download the cost report data each quarter in order to
have the most up to date information
Options for handing changes to the data files
10
Reopened Cost Reports
Cost reports can be “Reopened”, which means that it
was opened again by the provider, the Medicare
Administrative Contractor (MAC), or CMS
Cost report can be reopened for up to 3 years starting
from the settlement date otherwise known as Notice
of Program Reimbursement (NPR).
If not reopened within 3 years, the cost report
becomes final.
Only exception to this rule is in the case of fraud.
11
FY 1996 Cost Reports Status Changes
12
0
500
1,000
1,500
2,000
2,500
3,000
2002 Update 2006 Update 2010 Update 2013 Update
As Submitted Settled Settled w/Audit Reopened
Reopened Cost Reports
Same situation as constantly changing download
Depending on your study, researchers may need to
˗ Download a point in time cost report data set and work
with that set for the project
˗ Download the cost report data each quarter in order to
have the most up to date information
Options for handing reopened cost reports
13
Time Lag
Cost Report due to Fiscal Intermediary (FI) 5
months after the close of the provider’s Fiscal
Year.
Usually takes about 12-18 months for the latest
FFY to be complete.
See flow chart at the end of this segment.
FFY 2012 Hospital Cost Reports Completion
14
Update Percent Complete
March 2013
(6-months past FFY end)
14%
June 2013
(9-months past FFY end)
53%
Cost Reports Time Lags
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
FFY 2007 FFY 2008 FFY 2009 FFY 2010 FFY 2011 FFY 2012
FY End Dt & MAC Receipt Dt FY End Dt & Dt in HCRIS
Median Number of Months
15
Time Lags
Be aware that it may take some time for the cost
reports to appear in the download
This may influence the years you include in your
analysis
Options for handing time lag
16
Free-Standing Facilities vs Provider Based
Cost report download includes free-standing facility and any provider-based facility
The forms used to collect the information differ between free-standing facilities and provider-based facilities.
17
Free-Standing Facilities vs Provider Based Some provider cost reports are located in multiple
databases
˗ SNF (found in 2 downloads)
» Free-standing SNF and Hospital download
˗ RHC (found in 4 downloads)
» Free-standing RHC, Hospital, SNF, HHAs
˗ HHA (found in 3 downloads)
» Free-standing HHA, Hospital, SNF
˗ Hospice (found in 4 downloads)
» Free-standing Hospice, Hospital, SNF, HHA
˗ Renal (found in 2 downloads)
» Free-standing Renal facilities, Hospital
18
Determining Reliability of Data
Consult the instructions for completing the worksheet
(PRM 15-2)
˗ Is the Worksheet or variable required?
» Within the PRM 15-2 (“pr2_40” for Hospitals)
˗ Is the Worksheet or variable audited?
» Within the Electronic Reporting Specifications
(“R3P240S”), Table 6: Edits, Level I & II
˗ What electronic edit checks are in place for this
variable?
» Within the Electronic Reporting Specifications
(“R3P240S”), Table 6: Edits, Level I & II
19
Determining Reliability of Data
Determine if the variable is used in the settlement
summary
˗ Worksheet E
Check the number of missing or extreme values in the
data
20
Why Use the Cost Report Data?
Only national data available for all types of
providers
˗ Non-profit
˗ For-profit
˗ Government
But remember…
21