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MEDICARE WAGE INDEX PROJECT
MICHIGAN HEALTH & HOSPITAL ASSOCIATION
BAKER HEALTHCARE CONSULTING, INC.
FEDERAL FISCAL YEAR 2019
FFY 2015 (Years ended September 30, 2015 through September 29, 2016) AND SUBSEQUENT YEARS DATA
(Materials for Use in the Summer of 2017 through Fall 2017)
The enclosed information is prepared by Baker Healthcare Consulting, Inc. (BHC) based on research of policies, regulations and rulings of the Centers for Medicare and Medicaid Services (CMS), discussions with CMS and Medicare Administrative Contractor (MAC) personnel. Such interpretations may not always be consistently applied throughout the US and are subject to further interpretations. Accordingly, BHC cannot warrant the absolute accuracy of the data and conclusions included herein.
©2017 Baker Healthcare Consulting, Inc.
THE MEDICARE WAGE INDEX PROJECT
FFY 2019 (Data from FFY 205)
Table of Contents Contacts ................................................................................................................................................... 1
Initials, Acronyms and Technical Jargon .................................................................................................. 2
Hospital Data Used For Medicare Wage Indexes ..................................................................................... 6
Calculation of a Wage Index ..................................................................................................................... 7
Uses of the Medicare Acute Care Wage Index ......................................................................................... 8
Impact of 1% Increase on the Wage Index ............................................................................................... 9
National Average Hourly Wage FFY 1999-2017 (and Est 2018) ........................................................... 10
FFY 2019 Hospital Wage Index Development Timetable ...................................................................... 11
Critical Path for Protecting Appeal Rights.............................................................................................. 15
Sample Letter to CMS to Protect Appeal Rights .................................................................................... 16
2018 Medicare Wage Index Tables (from Proposed Rule) ..................................................................... 17
What is My Guide for Materiality? ......................................................................................................... 18
Hot! Issues
New FFY 2017 Special Rules Applicable to FFY 2018 ......................................................................... 19
MAC Desk Review ................................................................................................................................. 20
CMS High End Aberrant Data Reviews ................................................................................................. 21
Pension Expense on Defined Benefit Plans for FFY's 2017 and 2018 ................................................... 22
Occupational Mix Survey, The Basics, A Key Instruction ..................................................................... 23
Nursing Aides and Orderlies ................................................................................................................... 28
OMA Survey Support Tools ................................................................................................................... 29
Imputed Rural Floor ................................................................................................................................ 32
Urban Hospital Reclassification to Rural ................................................................................................ 33
CMS Adjustment after January 16, 2018 ................................................................................................ 35
1% Exception Provision .......................................................................................................................... 36
PTO Paid at Termination ........................................................................................................................ 37
Contract, Dietary and Housekeeping ...................................................................................................... 38
Legal, Consulting and Audit Fees ........................................................................................................... 39
Recording of Hours in July 2009 Instructions to S3, Part II ................................................................... 40
Other A&G Contract Service .................................................................................................................. 41
Medicare Group Appeals A Primer ........................................................................................................ 42
Wage Index and Geographic Reclassification Controversies ................................................................. 48
Wage Index Is a Priority Issue ................................................................................................................ 56
Work Plan ............................................................................................................................................... 58
2018 Special Considerations ................................................................................................................. 70
Using the Three Year Statistical Comparison ......................................................................................... 71
Wage Related Costs ............................................................................................................................... 74
2018 Pension Reporting Requirements……………………....... ............................................................ 75
Domestic Claims and TPA Approach ..................................................................................................... 76
CMS Self-Funded Insurance .................................................................................................................. 77
Formula Determining Physician Wage Related Costs ............................................................................ 79
Accurately Determining Physician Part A Costs .................................................................................... 82
How to Obtain Physician Time Studies -The Easy Way ......................................................................... 83
Background on Contract Services ........................................................................................................... 84
A Primer on Contract Services ................................................................................................................ 85
Checklist for Completing the Wage Index Review ............................................................................ 87
Tips for Completing the Wage Index Review......................................................................................... 88
Sample MAC Transmittal Letter ............................................................................................................. 89
Wage Index Costs (Core) ........................................................................................................................ 90
BACKGROUND DATA (Pagination repeats – Page 1 for example)
WAGE INDEX PROJECT
CONTACTS Dale E. Baker President Baker Healthcare Consulting, Inc. Telephone: 317-631-3613 Fax: 317-631-0302 EMail: bakerhealthcare@yahoo.com
Joseph R. Krause, Esq., CPA Director Baker Healthcare Consulting, Inc. Telephone: 414-721-0906 Email: jkrause@baker-healthcare.com
Kellie L. Crowe Assistant to the President Baker Healthcare Consulting, Inc. Email: bakerhealthcare@yahoo.com
Vickie Kunz Senior Director Michigan Health & Hospital Association Telephone: 517-703-8608 Email: vkunz@mha.org Baker Healthcare Consulting is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.learningmarket.org
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