Supplemental Worksheets for Inpatient and Outpatient PCCM Charges
Descriptive Overview:
A letter has been sent to providers concerning a review of the Primary Care Case Management (PCCM) program reimbursement data for inpatient services and the steps needed to facilitate the review. Click on the title to view the letter.
Article:
The Texas Health and Human Services Commission (HHSC) will conduct a review of the Primary Care Case Management (PCCM) program reimbursement data for inpatient hospital services. In order to complete this review, HHSC requires hospitals to include PCCM data in their Centers for Medicare & Medicaid Services (CMS) Form CMS-2552 Hospital Cost Report. HHSC is reviewing hospital cost data from federal fiscal year 2008 (October 1, 2007, to September 30, 2008) and requires each hospital that submitted a cost report, which covered any portion of the hospital fiscal year, to submit two additional supplemental worksheets reporting PCCM data. The supplemental worksheets include D-4 worksheet and D, Part V worksheet for PCCM Inpatient and Outpatient Charges.
Instructions for completing the supplemental worksheets:
Because of limitations of Form CMS-2552 in providing additional forms for the separation of the hospital Title XIX traditional fee–for-service and the PCCM charge data, HHSC requires that these new supplemental worksheets be submitted with all future hospital cost report submissions. The reporting of PCCM data for hospital cost reports submitted within federal fiscal year 2008 was completed by a few hospitals within the current Form CMS-2552, although this was not consistent with every hospital. The new supplemental worksheets will allow for a consistent methodology to capture PCCM charge data and provide a mechanism for analysis. Please note for hospitals that have received a PCCM settlement, the supplemental worksheets indicating PCCM charge data may result in a change in the hospital settlement amount for periods included in federal fiscal year 2008 and forward. In order to assist you with this process, your PCCM medlogs are included with this letter.
If during the completion of the PCCM supplemental worksheets, the hospital determines that there are any other changes that need to be made to their cost report, including the separate reporting of PCCM and traditional fee-for-service claims that had been combined in the Title XIX worksheets of prior submissions, the provider will need to file an amended cost report along with the included supplemental worksheets.
Please submit amended cost reports and supplemental worksheets to the following address:
Texas Medicaid & Healthcare Partnership
Medicaid Audit
PO Box 200345
Austin, TX 78720-0345
For overnight delivery, our physical address is:
Texas Medicaid & Healthcare Partnership
Medicaid Audit
12365-A Riata Trace Parkway
Austin, TX 78727
The required supplemental worksheets must be completed and postmarked for delivery to TMHP by September 15, 2009. If you would like to request these worksheets electronically, please contact Lamont McKenzie at (512) 506-7395 or at lamont.mckenzie@tmhp.com. Providers may also download these forms from www.tmhp.com.