Health Care Payment Reform Center

DSH S-10 Worksheet

Cost Report Worksheet S-10 – Uncompensated Care

The final federal fiscal year (FFY) 2018 Medicare inpatient prospective payment system (IPPS) rule solidified the proposal to incorporate uncompensated care cost information from Worksheet S-10 (S-10) of the Medicare cost report beginning in FY 2018. This will cause significant redistributions of the uncompensated care portion of Medicare disproportionate share hospital (DSH) payments among providers.

To assist affected organizations, the Centers for Medicare & Medicaid Services (CMS) allowed providers multiple opportunities to submit revisions for FYs 2014 and 2015. We also encourage hospitals to review their FFY 2016 S-10 schedules and amend accordingly.

Hospitals should review their S-10 information as soon as possible and calculate the potential impact of this shift in the Medicare DSH payment methodology.

How can I assess my organization’s potential financial impact?

It’s difficult to accurately assess how this rule will affect each organization. However, we’ve developed a tool to help providers estimate and plan for the potential impact. To request the tool, please complete the information below so we can email it to you.

How could this affect my organization?

The final rule will drive future payments, and many organizations could see a significant change in Medicare DSH payments beginning in FY 2018. Further, if errors are identified during an S-10 audit, extrapolations reducing Medicare DSH payments are likely.

What actions can I take now?

  • Verify detailed patient listings are available to support S-10 filed amounts
  • Ensure that filed amounts are compliant with Medicare cost report instructions
  • Check that policies, procedures and reporting are compliant and consistent
  • Evaluate how current cost report instructions and potential changes will affect cost report instructions on uncompensated care reporting


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