2023 Institutional Cost Report (ICR)

NYS Department of Health
Division of Finance & Rate Setting
Bureau of Hospital & Clinic Rate Setting

  • Presentation is also available in Portable Document Format (PDF)
ICR Road Shows: April 15, 2024 - April 18, 2024

Agenda

Software to Use

➣ HFS MCRIF32 Software (NEW for 2023)

  • 2023 Institutional Cost Report (ICR) and Medicare Cost Report (MCR) Submissions
  • Has backwards compatibility
  • Final version pending release from Health Financial Systems (HFS)

➣ Legacy Compu-Max Software

  • 2021 ICR Audit Resubmissions (audit is currently ongoing)
  • 2022 ICR Resubmissions (until DOH directs otherwise)
  • May use to start 2023 ICR & MCR – do not submit
    • HFS Report Wizard may be used to convert files for new HFS Software

Software, Support & Electronic Filing Procedures

  • ➣ Obtaining Software and Support
    • HFS MCRIF32 Software will be available for download from the HFS website.
      • Hospitals were notified on 1/23/2024 and 2/26/2024 to register through HFS
        • Registration is ongoing
      • MCR software is available for download now, ICR portion is pending release
    • ICR support, problem resolution, and questions:
      • Send email to: Hospital.ICR@health.ny.gov
      • Include in subject line: "2023 ICR - hospital name"
      • For problem resolution, send your ".mcrx" file to this email address. The file will then be forwarded to HFS, if necessary.
        Note: Please do not send files via secure e-mail (only necessary when PHI data is present)
  • ➣ Electronic Filing Procedures
    • DH file: Electronic submission through Health Commerce System (HCS) - Hosp Institutional Cost Rpt application):
      • Due date: Friday, June 14, 2024 (ICR ONLY)
    • Supporting documents due within 5 business days of ICR submission to be considered a valid cost report submission
      • Signed CFO/CEO certification (verify Document Control Number (DCN) matches ICR)
      • Audited Financial Statements (Final)
        • ✤ "Draft" statements are not acceptable for audit purposes
      • Audit Fee Form (Proof of Payment)
    • Email supporting document files to: AFS@health.ny.gov
      • Signed CFO/CEO Certification:
        • ✤ File named with 7-digit operating certificate number and "_CFO"
          • Example: 1234567_CFO
      • Audited Financial Statements:
        • ✤ File named with 7-digit operating certificate number and "_AFS"
          • Example: 1234567_AFS
      • Audit Fee Form:
        • ✤ File named with 7-digit operating certificate number and "_AFF"
          • Example: 1234567_AFF
        Note: Please do not send files via secure e-mail (only necessary when PHI data is present)
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2023 ICR Audit Fees

  • ➣ Audit Fee Payment/Form
    • Due within 5 business days of filing ICR
    • Same banking information as previous years
    • Same fee schedule as previous years - available on DOH website
    • Email notification to be released for facility-specific audit fees
    • Additional fees may be assessed when # of submissions exceeds 2
    • Email completed Audit Fee Form to: AFS@health.ny.gov
      • One form may be used to report fees paid for multiple hospitals in a system
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Health Commerce System (HCS)

  • ➣ Website
  • ➣ Communication Tool
    • Secure network for posting provider information
    • Important to keep email address current to receive notifications
      • User's responsibility
      • Email list is separate from the DOH public website electronic mailing lists
  • ➣ HCS Help Contact
    • Commerce Accounts Management Unit: 1-866-529-1890 or camu@its.ny.gov
      • HCS accounts
      • Password resets
      • Removal of employee
  • ➣ HCS Access Contact
    • Hospital Fee-for-Service Rate Unit: HospFFSunit@health.ny.gov
      • Receiving access to the ICR (or other hospital applications)
      • Rate related questions
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Department of Health Public Website

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2023 ICR Updates

  • ➣ Exhibits (changes, additions & clarifications)
    • Exhibit 1 (Hospital Identification Data)
      • Report inpatient service closures
        • ✤ Only when entire service closes for an exempt unit area (i.e., All Psychiatric Units)
        • ✤ Only when entire service closes for an exempt unit area (i.e., All Psychiatric Units) Indicate if permanent or temporary and date
    • Exhibit 33 (Outpatient Statistical Data, Visits by Source)
      • "Other" service area added
        • ✤ To be used for non-standard Outpatient services
        • ✤ Must add header label (avoids fatal edit)
        • ✤ Ensure proper Medicaid Service Code assignment
    • Exhibit 41 (Medicaid Funded Depreciation Schedule)
      • Negative depreciation values may not be reported for:
        • ✤ Depreciation Expense
        • ✤ Capital Asset Purchases
        • ✤ Capital Debt Payments
  • ➣ Edits
    • New edits
      • Highlight inconsistencies between reported utilization, costs and/or charges
      • All new edits/changes to edits will be highlighted in the edit listing
    • Importance of Edits
      • Improve data integrity
        • ✤ Budgetary Analysis, DSH Model, Directed Payments, etc.
      • Highlight data anomalies
        • ✤ Low utilization, positive values entered as negatives & vice versa, etc.
      • Help reduce ICR audit findings and/or questions
        • ✤ May prevent reporting errors and avoid audit findings
        • ✤ Edit explanations reviewed by DOH and provided to auditors
    • Types of Edits
      • Fatal (3xxxx)
        • ✤ Identify the cause and make appropriate correction(s)
        • ✤ Notify ICR mailbox when edit is believed non-applicable and cannot be cleared
      • Non-Fatal (4xxxx)
        • ✤ Intent is to identify unexpected data or combinations
        • ✤ Only change data if an entry is incorrect or omitted
        • ✤ Do not make changes to unsupported values just to clear edit(s)
          • ✓ Edits comparing Exhibit 3 (S-3, Part I) versus Exhibits 32, 33, & 34 (Utilization)
          • ✓ PS&R versus Patient Financial System
        • ✤ All non-fatal edits require a valid explanation
    • Edit Responses
      • Explanations should provide insight
        • ✤ Cannot be left blank (Fatal Edit)
        • ✤ Should not state "Confirmed", except for edits requesting confirmation (ex - edit 41806)
          • ✓ Stating "Correct", "Affirmed" or similar is insufficient
        • ✤ Should not state "Will review during audit"
        • ✤ Adequate explanations will help avoid inquiries from DOH/auditors

Note: Any edits that require reporting corrections should be done BEFORE filing either the Medicare or Medicaid cost report

  • ➣ Primary Payor Reporting
    • After posting the Explanation of Benefit (EOB), self-responsible amounts are still the primary payor
      • Not the secondary payor, if different from primary
      • Not self-pay or uninsured
    • Charity Care Primary Payor
      • Only if entire account does not have third-party coverage and was or is to be written off
      • Hospital Financial Aid Law (HFAL)
        • ✤ Use lines 382, 383, 386 and 391 on Exhibit 46 to report Charity Care reductions
    • Payor changes for later eligibility determination
    • Centers for Medicare and Medicaid Services
      • Issued Final Rule on February 23, 2024
      • The DSH Third-Party Payer Rule (89 FR 37, pp. 13916–13948)
      • Ensure that Primary payor is being reported appropriately
      • ICR Instructions and/or FAQs to updated based on ongoing discussions with DSH Team
  • ➣ Offsets
    • Typically, would reduce revenue or expense to zero
      • Unless limited, such as interest restricted in use by donor of principal
    • Should not result in negative expense
      • Offset shouldn't exceed expense amount
    • Reminders
      • When including ending accrual, consider beginning accrual
      • Use hard-coded lines on Exhibit 18, when available
        • ✤ Parking, lines 068 and 069, Malpractice line 025
      • Expenses reported on exhibit 18 are after reclasses and adjustments
  • ➣ Reminders
    • 2023 ICR Submissions
      • Please review past audit findings and/or adjustments to avoid similar reporting errors
      • Backup documentation for various exhibits should be kept on-hand for audit purposes
      • DCN's should match - ICR submission and CFO certification
      • Recommended - submit audited financial statements and CFO certifications same day as ICR submission
      • Initial ICR submission should always include the most accurate data
        • ✤ Unaudited data may be used by the Department at any time
        • ✤ Ready to be audited (do not plan to fix exhibits during audit)
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Questions?

ICR Questions: Hospital.ICR@health.ny.gov

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