The last few weeks I’ve fielded many questions related to CMS requiring hospitals to report their payer contracted rates in the cost reports.
Let me provide a quick refresher on this issue. On Monday, May 11, 2020, CMS’s Proposed Rule requires hospitals to report, on its cost report:
(1) The median payer-specific negotiated rate that the hospital has negotiated with all of its Medicare Advantage payers, by MS-DRG;
(2) The median, payer-specific negotiated rate the hospital has negotiated with all of its third-party payers, by MS-DRG.
The payer-specific contracted rates would have to be reported on cost reports with periods ending on or after 1/1/21.
CMS claims it is trying to set fair MS-DRG payment rates that are not based on the chargemaster, which CMS calls, “inherently unreasonable when judged against prevailing market rates.”
If your organization needs help calculating its payer-specific contracted rates for compliance, we can help.
Here's my private calendar to set up a mutually-convenient time to talk: go.oncehub.com/ricklouie