Following the recent Supreme Court decision in Advocate Christ Medical Center v. Kennedy (HHS), we’re seeing a wave of remand and settlement letters being issued for old Cost Report Years. These actions aim to implement the Court’s ruling across affected providers.
In reviewing one such letter for a client, GDS identified a significant issue: the Medicare Administrative Contractor (MAC) proposed to use an incorrect SSI (Supplemental Security Income) ratio. While the value referenced did match a published CMS SSI chart and corresponded to the provider’s correct fiscal year, it was taken from an incorrect chart.
Had this error gone unnoticed, it would have resulted in a loss of nearly $200,000 for the provider.
This review underscores the importance of a thorough review of all data elements in remand or settlement letters, particularly when it comes to SSI ratios—which have a direct impact on DSH payments and related reimbursements.
GDS is a leading expert in SSI Ratios (including realignments), Medicare DSH, 340B qualification, and many other Reimbursement and Revenue Cycle matters. Contact Adam Blackwell for a complimentary conversation.