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Hospice FY2017 PROPOSED Wage Index, Payment Update and Quality Reporting Rule
Hospice Payment Reform White Paper
Monthly Model for Calculating Hospice Payment under New Rule

The model used to analyze the impact of the Fiscal Year 2016 payment rule. Please note the following regarding the model:

  • The model is constructed where you would have to enter the patient name (optional), patient admission date, discharge date (if the patient is not discharged, it is OK to leave this field blank) and whether the discharge is due to death (answer should be Yes) or a discharge alive (the answer should be No). All of this information is to be entered into the Input tab.
  • The input tab is set up so that you can input up to 450 different patients. If you have more than 450, please use the spreadsheet more than once. Please note that you must delete any lines where you do not have patient information.
  • The spreadsheet is set up so that you can use any month-there is a tab that is called period data. This tab allows you to enter the particular month you are reviewing.
  • Once the information is input, the spreadsheet will calculate the following:
    • The column labeled active will look at the discharge date column-if information is in the field, then it will pull that information; if blank, then it will put the last day of the month.
    • The column labeled prior month will determine if the admission is for the current month or the prior month-if the current month, it will pull the admission date; if for a prior month, it will pull the first day of the month.
    • The column labeled days on month calculates the days based on the active and the prior month dates; it also adds a day if the column for death is a yes.
    • Columns K, L, and M will break out the days into Old Days and New Days. (K and L are old days)
    • Column H uses the data in K/L/M to determine the average reimbursement for the patient.
    • Column I aggregates the weight for the patient (Column H times the number of days) to calculate the aggregate weight for the agency.

Please note an example of the calculation is included in the tab labeled example.

The SIA days tab takes the total patient days from the input tab. It then asks the agency to estimate the number of hours per patient day to calculate the SIA payment. There is an entry field for your Wage Index value; please be sure to enter a value in this field.

The SIA tab then compares the SIA payment to what the agency would have received if there was no SIA. As a reminder, CMS reduced the SIA payment by a budget neutrality factor (1.94% for all routine home care days between one and sixty, and 0.43% for those days sixty one and plus). This is a FYI to show you the comparison between what you will be paid compared to the budget adjustment.

Download file: Monthly Model for Calculating Hospice Payment under new rule, November 2015

Hospice Charges Worksheets
Managed Care Tool Kit
NAHC/HHFMA/HAA Palliative Care White Paper June 2015
HHFMA Medicare Advantage Managed Care Survey October 2014
HHFMA Cost Efficiencies White Paper June 2014
RATE REBASING IN MEDICARE HOME HEALTH SERVICES: An HHFMA White Paper April 2012
REPORT OF THE HHFMA HOSPICE REFORM TASK FORCE January 2009
Analysis of Medicare Margins
For Home Health Agencies October 2006
Medicare Prospective Payment System Revenue Recognition Models 2003
Palliative Care: A Business Analysis of the Pros and Cons of Establishing a Palliative Care Program

HHFMA-sponsored webinar, February 15, 2013.
With special thanks to hosts BKD CPAs and Advisors

Powerpoint Presentation from the Webinar (PDF file)

Managed Care Cost Assessment Tool
Cost Report Data Reports

I. INTRODUCTION

The NAHC COST REPORT DATA COMPENDIUM is an in-depth analysis of Medicare cost reports filed by home health agencies since the beginning of the HH PPS payment system in October 2000. NAHC has acquired nearly 150,000 filed cost reports to develop this Compendium.

The Compendium is a valuable tool for providers of services, consultants, health policy planners, home care advocates, investors, and trade associations looking to gain an understanding of the financial status of home health agencies. However, it must be understood this tool is not intended to be used to affect the planning and delivery of care to individual patients. It must be further understood that while the methodology used by NAHC to conduct this analysis has been validated the cost report data used is unaudited.

II. DESCRIPTION OF THE DATABASE

Annually, all Medicare participating home health agencies file a cost report with the Medicare program. An abbreviated report is filed by low/no utilization home health agencies. This database excludes those abbreviated reports and contains only the full reports filed by home health agencies that are actively engaged in providing Medicare services.

Cost reports must be filed within five months of the close of the provider’s fiscal year. In most cases, the provider chooses the dates of its fiscal year. It is NAHC’s experience that approximately one-half of the HHAs choose a January 1 to December 31 fiscal year and that about 30% use a July 1 to June 30 year. The remainder are scattered throughout the calendar year.

The cost reports used in this Compendium come from the public use file maintained by the Centers for Medicare and Medicaid Services.

Cost reports contain a wealth of data. For purposes of this Compendium, NAHC used data on per unit costs, supply costs, service utilization, and Medicare PPS episodes. In addition, overall HHA cost and revenue data is used to calculate overall financial margins. The geographic location of the HHA and its categorization also is utilized.

In 2014 there were more than 12,500 Medicare participating HHAs. Considering that approximately 15% are low/no utilization HHAs, approximately 10,265 full cost reports were filed. Each year NAHC does not use a number of these reports because of anomalies and missing data. As a result, there is a variation in the number of cost reports used dependent on the item calculated.

This compendium presents results on the basis of Fiscal Year End Reports as well as results of certain specific fiscal years.  A total of 9,302 reports after trimming unusable reports from 2014 were available at the time of the data analysis.

National Profit Margin Detail Reports
All
Free-standing Agency
Free-standing, Rural Agency
Free-standing, Urban Agency
Hospital based Agency
Hospital based, Rural Agency
Hospital based, Urban Agency
Rural Agency
Urban Agency
National Profit Margin Categorized Reports
All
Free-standing Agency
Free-standing, Rural Agency
Free-standing, Urban Agency
Hospital based Agency
Hospital based, Rural Agency
Hospital based, Urban Agency
Rural Agency
Urban Agency
National Visits per Episode Reports
(using agencies with a visits to episode ratio between 6 and 100)
All
Free-standing Agency
Free-standing, Rural Agency
Free-standing, Urban Agency
Hospital based Agency
Hospital based, Rural Agency
Hospital based, Urban Agency
Rural Agency
Urban Agency
National Overall Profit Margin Summary Reports
(Free-standing agencies only)
Free-standing Agency All
Free-standing, Rural Agency
Free-standing, Urban Agency

Archived cost reports are available here.

New Uniform Chart of Accounts for Industry

The National Association for Home Care & Hospice and the Home Care & Hospice Financial Managers Association released The Uniform Chart of Accounts. The purpose of creating a uniformity of financial reporting, Medicare cost reporting and financial analysis will allow for accurate data collection and analysis that can be used for improved business management and in advocacy efforts with the Center for Medicare and Medicaid Services (CMS) and Congress. The Uniform Chart of Accounts provides for all product lines that are considered to be included under their umbrella of Home Care.

The Uniform Chart of Accounts has been completed by a committee made up of members of the Home Health & Hospice Financial Managers Association (HHFMA). The intent of the members of HHFMA’s Uniform Chart of Accounts Committee is that member agencies of both HHFMA and NAHC will review this Uniform Chart of Accounts and make every effort to revise their chart of accounts so as to fall within this recommended structure. This Committee has also included suggested formats for Statements of Revenue and Expense for Home Health Care (Skilled Intermittent services), Hospice, Private Duty, Pharmacy and Infusion Therapy as guides for assisting in the necessary ongoing financial analysis of each specific product line.

This project was originally undertaken by a Joint Committee formed by the Illinois Home Care Council and the Indiana Association for Home Care in 1992. The Joint Committee was co-chaired by Pat Laff and Dave Elwell. Its other members included John Gaynor, Tom Galluppi, Renee Hyde and Elaine Ricci. The joint committee consisted of significantly experienced provider financial executives as well as home health and hospice financial consultants. The project was completed in 1994, but funding for the project was discontinued and its final product was never published. That product formed the basis for the completed and finalized Uniform Chart of Accounts (see below).

Pat Laff, chair of the HHFMA Uniform Chart of Accounts Committee, acknowledged the work and dedication of its members, without whom this result could not have been achieved. The members include Ed Nicolas – VNS of Connecticut, Jeff Kolcum – Family Home Care, Katherine Jones – Guardian Home Care, Mark Tsiames – Simione Consultants, Vern Peterschmidt – Peterschmidt and Associates and Dave Stasiewicz – Addus Healthcare, Inc.

New Uniform Chart of Accounts for Industry
Home Health Financial Statement from Trial Balance Template 09-by payor
Home Health Financial Statement from Trial Balance Template-per visit
Home Infusion-Pharmacy Financial Statement format
Hospice Financial Statement from Trial Balance Template
Private Duty Financial Statement Template
HHA and Hospice Financial Statement from Trial Balance Template
HHFMA – Chart of Accounts with Account Explanations