Industry Insights

What’s the PS&R Report & How Can It Help Me?

July 2017
Author:  Rikki Holmes

Rikki Holmes

Managing Consultant

Consulting

Health Care

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
417.865.8701

The Provider Statistical and Reimbursement (PS&R) System report provides key payment and statistical data for skilled nursing facilities (SNF) applicable to processed and finalized Medicare Part A and Part B claims. The two primary reports providers can access are the Provider Summary Report and Payment Reconciliation Report (also known as the detail report). A SNF provider can request these reports on the Enterprise Identity Management (EIDM) system. EIDM is the Centers for Medicare & Medicaid (CMS) secure web-based system that provides access to many CMS systems, including the PS&R System. Information regarding EIDM access can be found here.

The PS&R summary report is divided into four sections for Medicare claims:

Statistic Section

  • Discharges and patient days (Part A)
  • Claims (Part A and Part B)

Charge Section (By Revenue Code)

  • Accommodation – Room and board and leave of absence charges (Part A)
  • Ancillary charges (Part A and Part B)

Reimbursement Section

  • Gross reimbursement
  • Less deductibles, coinsurance, secondary payments, sequestration and other reductions

Additional Information Section

  • Resource Utilization Group (RUG) use to assist providers in completing Worksheet S-7 of their Medicare cost report (Part A)
  • Claim interest payments and other (Part A and Part B)

A provider can run a summary PS&R report at any time with no limits. The report is available in PDF or comma-separated values formats. The PS&R system is updated once the paid claim submitted from the Medicare Administrative Contractor (MAC) clears the PS&R load control process. Providers can use PS&R reports for benchmarking, reconciliation to their billing software and verification of information submitted to Medicare. For cost report and reconciliation purposes, providers should request ALL summary reports. However, if specific information is needed, individual reports or groups of reports can be requested, i.e., inpatient only or outpatient only. Providers should compare data per the PS&R to their internal records. An average Part A daily RUG reimbursement rate can be calculated as well as a Part B average reimbursement rate. Are the PS&R rates comparable to the provider’s internal calculated rates? Material differences should be investigated for possible rate or billing errors.

Providers can use the PS&R, internal Medicare payment logs or a combination of both for Medicare cost reporting preparation. If a provider is behind in Medicare billing, internal logs likely would provide more accurate cost report data than a PS&R. Eventually, the MAC will adjust Medicare cost report statistical, charge and payment data to the most recent PS&R. The Medicare cost report only should include traditional Medicare Part A data and Medicare Part B cost-reimbursed data, i.e., vaccines. Medicare Advantage and Part B fee reimbursement data shouldn’t be included on the Medicare cost report.

The Payment Reconciliation Report, also known as the detail report, can be requested on the EIDM system; however, the report won’t be available for download. This report contains detailed, claim-specific data that supports the summary report. If the MAC approves the request for a detail report, they will download the report to a password-protected CD. This CD is then mailed to the facility. One detail report can be requested annually for free. Requesting the detail report more frequently may result in a fee.

The PS&R report is an easy tool for providers to use for timely analytics. Don’t wait until after year-end to download this useful report. For more information, contact your BKD advisor.

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