Profile Definitions and Methodology
Profile
The report you are viewing for with period ending uses the 2552-10 format.
The following definitions are also based on that format.
Please note:
- Information used for searches is based on a hospital's most recent cost report.
- Information reported on the Profile page is based on the reporting period selected.
- Hospital provider number, name, and address
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A hospital's Medicare provider number, name, and address are taken from Worksheet S-2. The Electronic Code is a code assigned by CostReportData.com to assist in resolving questions.
- Other Reporting Periods
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Hospitals are required to file a cost report for each fiscal year. After searching for a hospital and selecting a particular reporting period, you can subsequently change to other periods on the Profile or on the header of any worksheet. This convenient feature is available to navigate among periods ending in 1996 through 2010 (CMS-2552-96 format) or ending in 2011 through the present (2552-10 format)
The Other Reporting Periods pulldown on the Profile and in the header of each worksheet can be used to change to a different year’s cost report.
- Filing Date and Status
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Once you have selected a reporting period (ending in 2011 through the present), you can then select among prior filings. After initial submission, cost reports may be amended, audited or otherwise updated. Multiple filings are included in HCRIS data and are identified by their filing date and status. (If there are two filings within a quarter, however, only the latest filing is included in HCRIS.)
The Filing Date & Status pulldown on the Profile and in the header of each worksheet can be used to change to a different filing.
- Type of Facility
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The type of facility is determined from the last four digits of its Medicare provider number:
Short Term Acute Care 0001-0899 Childrens 3300-3399 Critical Access 1300-1399 Long Term 2000-2299 Psychiatric 4000-4499 Rehabilitation 3025-3099 Other none of above The Rural Emergency Hospital designation is determined from the Medicare Cost Report (Worksheet S-3, Part I, line 15.10).
- Type of Control
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A hospital's type of control is taken from the HCRIS file:
- Voluntary Nonprofit, Church
- Voluntary Nonprofit, Other
- Proprietary, Individual
- Proprietary, Corporation
- Proprietary, Partnership
- Proprietary, Other
- Governmental, Federal
- Governmental, City-County
- Governmental, County
- Governmental, State
- Governmental Hospital District
- Governmental, City
- Governmental, Other
- Urban/Rural Classification
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Medicare classifies a hospital as either "Urban" or "Rural" based on their Metropolitan Statistical Area. Hospital's can, however, be reclassified from rural to urban if they meet certain criteria. A hospital's designation (and reclassification date, if applicable) are taken from their most recent Medicare Cost Report (Worksheet S-2 Part I, Line 26, Col 1 and Worksheet S-2 Part I, Line 27, Col 1).
- Bed Size
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The number of staffed beds is taken from Worksheet S-3, Part I, line 14, col.2. Cost report instructions define staffed beds as, "the number of beds available for use by patients at the end of the cost reporting period. A bed means an adult bed, pediatric bed, birthing room, or newborn bed maintained in a patient care area for lodging patients in acute, long term, or domiciliary areas of the hospital. Beds in labor room, birthing room, postanesthesia, postoperative recovery rooms, outpatient areas, emergency rooms, ancillary departments, nurses' and other staff residences, and other such areas which are regularly maintained and utilized for only a portion of the stay of patients (primarily for special procedures or not for inpatient lodging) are not termed a bed for these purposes."
- Total Annual Discharges
The total number of inpatient discharges (all payors) is taken from Worksheet S-3, part I, line 14, column 15.
- Total Patient Revenue
The total patient revenue (inpatient and outpatient) is taken from Worksheet G-2, line 28, column 3.
- Period
The beginning and ending dates for a cost report are taken from Worksheet S-2 Part I, line 20.
- Status
The status of a cost report is taken from the HCRIS file:
- As Submitted
- Settled Without Audit
- Settled With Audit
- Reopened
- Amended
- Medicare Administrative Contractor
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A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. Prior to 2003 these contractors were referred to as Fiscal Intermediaries (FIs).
- Disproportionate Share (DSH Amount and DSH Ratio)
Medicare provides additional payment to hospitals that treat a disproportionate share of low-income patients. Qualifying hospitals receive a percentage increase in Medicare payments. This percentage increase varies depending on the ratio of low income patients and on certain statutory calculations. The Disproportionate Share (DSH) ratio is taken from Worksheet E, Part A, line 33. The amount of DSH payments is from Worksheet E, Part A, line 34.
- Outlier Amount
Medicare makes additional payments to hospitals for patients with costs that are extraordinarily high due to severity of illness and/or complicating conditions. The amount of outlier payments is from Worksheet E, Part A, line 2.
- IME Amount
Teaching hospitals receive additional Medicare payment due to the indirect costs associated with medical education programs. These payments are intended to cover the costs of additional tests and procedures ordered by interns and residents over and above what would have been ordered by more experienced physicians. The amount of the Indirect Medical Education (IME) adjustment is from Worksheet E, Part A, line 29.
- GME Amount
Medicare pays a hospital for the costs of an approved direct Graduate Medical Education (GME) program. These costs include the direct cost of salaries and benefits for interns, residents, and teachers. The amount of GME payment is from Worksheet E, Part A, line 52.
- Total IP Reimbursement
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The 2552-10 format calculates IP Reimbursement across several potential sheets.
PPS Worksheet E, Part A, line 59 TEFRA Worksheet E-3, Part I, line 18 Psych Subprovider Worksheet E-3, Part II, line 31 Rehab Subprovider Worksheet E-3, Part III, line 32 LTCH PPS Worksheet E-3, Part IV, line 22 Critical Access Hospitals (CAHs) Worksheet E-3, Part V, line 30 PPS SNF Services Worksheet E-3, Part VI, line 15 Titles V or XIX Services Worksheet E-3, Part VII, line 40 - Total IP Costs
Total IP Costs corresponding to Total IP Reimbursement are calculated in the cost report and summarized on Worksheet D-1, Part II, line 49.
- NPR Date
At the close of its fiscal year, a provider must submit a cost report to the MAC showing the costs it incurred during the fiscal year and the proportion of those costs to be allocated to Medicare. The MAC reviews the cost report, determines the total amount of Medicare reimbursement due the provider and issues the provider a Notice of Program Reimbursement (NPR). The NPR date is obtained from the most recent cost report data (HCRIS). There is no NPR date for cost reports as submitted or as amended by the provider (see Status above).
- NPR Settlement Amount
The NPR Settlement Amount is the Balance due provider/(Program). It is the difference between the Total IP Reimbursement (above) and the total interim payments for the cost reporting period less any tentative settlements previously made by the MAC.
PPS Worksheet E, Part A, line 74 TEFRA Worksheet E-3, Part I, line 21 Psych Subprovider Worksheet E-3, Part II, line 34 Rehab Subprovider Worksheet E-3, Part III, line 35 LTCH PPS Worksheet E-3, Part IV, line 25 Critical Access Hospitals (CAHs) Worksheet E-3, Part V, line 33 PPS SNF Services Worksheet E-3, Part VI, line 18 Titles V or XIX Services Worksheet E-3, Part VII, line 18 - NPR Settlement Percentage
This NPR settlement percentage is the NPR settlement amount as a percentage of total inpatient reimbursement. (It is calculated from the data elements previously defined.)