DSHRIP | Medicare Disproportionate Share (DSH) Revenue Improvement Program
GDS is best known for robust, accurate eligibility reports that are used by hospitals and consultants to support claims for Medicare disproportionate share hospital claims across the country. Hospitals and consultants choose GDS for our exceptional data analysis, deliverables, and customer service. Whether you choose to work with one of our world-class consulting clients for full-DSH services through the appellate process or choose to have GDS work directly with your internal staff to prepare the analysis and support for your cost report, GDS is prepared to deliver results to you. Our deliverables include all necessary supporting documentation to claim DSH reimbursement on your as-filed, amended, and re-opened Medicare cost reports.
The GDS Solution:
- Accurately identifies Title XIX DSH eligible Medicaid days, both in-state and out-of-state.
- Accurately identifies Title XXI (Medicare and Medicare Advantage for exclusion from the Medicaid fraction as called for by CMS.
- Identifies and quantifies days for purposes of claiming protested items and preserving your right to appeal. Thoroughly and accurately match babies to eligible moms.
- Includes a Labor and Delivery allocation as appropriate.
- Reviews days for appropriate exclusion from the denominator of the Medicaid fraction and/or Medicare fraction.
- Maximizes results through comprehensive analysis including multiple passes for same cost report year to capture retro-eligible days.
The Centers for Medicare & Medicaid Services (CMS) recently instructed Medicare Administrative Contractors (MACs) to allow hospitals to request a Supplemental Security Income (SSI) percentage realignment for any cost report period, at any time, regardless of whether the cost report is beyond its 3-year cost report reopening window. Prior to this announcement, CMS only authorized SSI realignments if the request was made no later than 3 years from the hospital’s Notice of Program Reimbursement (NPR).
This opportunity allows disproportionate share hospitals (DSH) to evaluate and request an SSI realignment going back to the inception of the DSH regulations.
- CMS has granted Government Data Services (GDS) access to the patient-level SSI data to determine which periods would benefit from a realignment with certainty.
- No other data is required from the hospital to perform the analysis.
- If we identify an opportunity for any Cost Report year prior to 1996, we will request Medicare Cost Report Worksheet E, Part A from you for such year(s), and we may request Settlement Documentation, in order to estimate the financial impact.