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DSH S-10 Uncompensated Care

Are You Receiving the Appropriate DSH Payment for Your Uncompensated Care?

The proposed federal fiscal year (FFY) 2019 Medicare inpatient prospective payment system (IPPS) rule continues to incorporate uncompensated care cost information from Worksheet S-10 (S-10) of the Medicare cost report. Redistributions of the uncompensated care portion of Medicare disproportionate share hospital (DSH) payments among providers is significant and will continue as a result of using two years of S-10 information for the calculation.

The Centers for Medicare & Medicaid Services (CMS) allowed hospitals to revise FFY 2014 and 2015 S-10 schedules by January 2, 2018. We encourage hospitals to review their FFY 2016 S-10 schedules and amend accordingly.

To complicate the matter, instructions change for cost reporting periods beginning on or after October 1, 2016, and understanding these revised instructions is imperative for compliance. In addition, the proposed rule, if finalized, will require hospitals to include a detailed listing of charity patients supporting the S-10 amounts or the Medicare cost report will be rejected.

Request S-10 Potential Impact Tool


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 in the form so we can email it to you.

How could this affect my organization?

The proposed 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

How can we help you?

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