J.23.A Government Provided Proposal Assumptions Audit and Reimbursement Tables.xlsx

XLSX spreadsheet 64 KB Posted Sep 4, 2019

Attached to: Part A/B Medicare Administrative Contractor, Jurisdiction E
Solicitation number: 75FCMC19R0023
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

About this file

Written by GovTribe AI · Dec 28, 2023

This document package includes an attachment from a Request for Proposal (RFP) and details of the associated federal contract opportunity. The RFP attachment provides instructions and tables outlining the Medicare provider populations and estimated workloads that an offeror would be expected to address as the Medicare Administrative Contractor for Jurisdiction E. This includes processing Medicare Fee-For-Service claims and payments for the states of California, Hawaii, Nevada, American Samoa, Guam, and Northern Mariana Islands. Offerors should propose costs and hours for provider audit, reimbursement, and education activities based on the facility counts and additional workload specifics provided in the various tables. The federal contract opportunity notice specifies that CMS intends to issue the RFP on September 4, 2019 seeking a contractor to perform Medicare claims administration services for Jurisdiction E. The base period of performance is one year with six one-year options. Proposals are due November 4, 2019 and award is anticipated for August 4, 2020, pending availability of funds. The award will be made using a best value tradeoff process.

From the source

RFP Attachment

View the file

Other files

File	Type	Posted
75FCMC19R0023_Amendment_2.pdf	PDF	Oct 17, 2019
Amendment_2,_Attachment_1_-_RFP_Question_Responses.xlsx	XLSX spreadsheet	Oct 17, 2019
JE_Amendment_1_CLEAN_Attachments_UPDATED.zip	ZIP file	Oct 8, 2019
Amendment_1,_Attachment_1_REDLINE_Backpages.pdf	PDF	Oct 8, 2019
JE_Amendment_1_REDLINED_Attachments_UPDATED.zip	ZIP file	Oct 8, 2019
JE_RFP_Questions_and_Responses_Amendment_1.xlsx	XLSX spreadsheet	Oct 8, 2019
75FCMC19R0023_Amendment_1.pdf	PDF	Oct 8, 2019
J.23 Government Provided Proposal Assumptions	—	Sep 4, 2019
J.39 CLIN 0006 Cost Proposal Template - Option Year 2	—	Sep 4, 2019
J.1.G AB MAC Performance Requirements Summary.docx	DOCX document	Sep 4, 2019
J.22 Basis of Estimate.xlsx	XLSX spreadsheet	Sep 4, 2019
J.42 CLIN 0009 Cost Proposal Template - Option Year 3	—	Sep 4, 2019
J.34 CLIN 0001 Cost Proposal Template - Implementation.xlsx	XLSX spreadsheet	Sep 4, 2019
J.1 Statement of Work	—	Sep 4, 2019
J.40 CLIN 0007 Cost Proposal Template - Option Year 2	—	Sep 4, 2019
J.28 Product Accessibility Template.docx	DOCX document	Sep 4, 2019
J.1.C Fee-For-Service Shared System Base Functions.docx	DOCX document	Sep 4, 2019
J.5 Government Systems Provided For Use.docx	DOCX document	Sep 4, 2019
J.46 CLIN 0013 Cost Proposal Template - Option Year 5	—	Sep 4, 2019
J.37 CLIN 0004 Cost Proposal Template - Option Year 1	—	Sep 4, 2019
J.45 CLIN 0012 Cost Proposal Template - Option Year 5	—	Sep 4, 2019
J.49 CLIN 0016 Cost Proposal Template - Outgoing Contractor Workload Transition Activities.xlsx	XLSX spreadsheet	Sep 4, 2019
J.10 Contractor Business Ethics COI and Compliance Program Requirements.docx	DOCX document	Sep 4, 2019
J.1.A List of Key Definitions.docx	DOCX document	Sep 4, 2019
J.33 Cost Template Summary Sheet.xlsx	XLSX spreadsheet	Sep 4, 2019
J.23.B Government Provided Proposal Assumptions CSR-Handled Telephone Inquiries Tables.docx	DOCX document	Sep 4, 2019
75FCMC19R0023.pdf	PDF	Sep 4, 2019
J.11 Personal Conflicts of Interest Financial Disclosure.docx	DOCX document	Sep 4, 2019
J.2 Deliverable Schedule.docx	DOCX document	Sep 4, 2019
J.1.D Cash Collections Worksheet For HIGLAS Users.xlsx	XLSX spreadsheet	Sep 4, 2019
J.44 CLIN 0011 Cost Proposal Template - Option Year 4	—	Sep 4, 2019
J.24 Attestations.docx	DOCX document	Sep 4, 2019
J.47 CLIN 0014 Cost Proposal Template - Option Year 6	—	Sep 4, 2019
J.3 Small Business Subcontracting Plan Template.docx	DOCX document	Sep 4, 2019
J.35 CLIN 0002 Cost Proposal Template - Base Year	—	Sep 4, 2019
J.32 Systems of Records.docx	DOCX document	Sep 4, 2019
J.48 CLIN 0015 Cost Proposal Template - Option Year 6	—	Sep 4, 2019
J.7 AB MAC Award Fee Plan and Self Assessment Template.docx	DOCX document	Sep 4, 2019
J.25 Past Performance Questionnaire.docx	DOCX document	Sep 4, 2019
J.4 HHS Contracting Guide for Contract of Government Property.docx	DOCX document	Sep 4, 2019
J.41 CLIN 0008 Cost Proposal Template - Option Year 3	—	Sep 4, 2019
J.43 CLIN 0010 Cost Proposal Template - Option Year 4	—	Sep 4, 2019
J.9 Non-Disclosure Statement.docx	DOCX document	Sep 4, 2019
J.1.B List of Key Acronyms.docx	DOCX document	Sep 4, 2019
J.36 CLIN 0003 Cost Proposal Template - Base Year	—	Sep 4, 2019
J.38 CLIN 0005 Cost Proposal Template - Option Year 1	—	Sep 4, 2019
J.8 MAC Security Incident and Reportable Event Reporting and Response.docx	DOCX document	Sep 4, 2019
J.6 Contractor Furnished Property.docx	DOCX document	Sep 4, 2019

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Instructions

Attachment J.23.A

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS AUDIT & REIMBURESMENT (A&R) TABLES

RFP # 75FCMC19R0023

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS A&R TABLES ATTACHMENT INSTRUCTIONS

FACILITIES BY TYPE INSTRUCTIONS

PURPOSE: The Facilities by Type tab presents the health care facilities populations that will be served by the A/B MAC. The table presents the health care facilities populations, by type, for the states serviced in this jurisdiction only. (See Facilities by State tab, Table #8 for information on health care facilities that will be served by the A/B MAC that are "out-of-jurisdiction.") The Offeror should use these facility counts when proposing hours and costs for its provider audit and reimbursement activities as well as provider education and outreach activities.

FACILITIES BY STATE INSTRUCTIONS

PURPOSE: The Facilities by State tab presents the health care facilities populations, by state and type, that will be served by the A/B MAC. This tab includes “out-of-jurisdiction” facility-type providers, many of which are chain affiliated providers. The Offeror shall assume that it will service all of these facilities for all periods of performance (BY, OYs 1-6). The Offeror should use these volumes when proposing hours and costs for its provider audit and reimbursement activities as well as provider education and outreach activities. The total health care facility mix of the A/B MAC will be comprised of the providers listed in Table #7-8.

ESTIMATED ANNUAL WORKLOADS INSTRUCTIONS

PURPOSE: The “Estimated Annual Workloads” tab presents additional specificity for the health care facilities populations, by type, for the states in this jurisdiction and other facilities outside the states serviced by the A/B MAC. The additional specificity is intended to relay more information relative to the level of effort required for the audit workload of the facility population for this jurisdiction. The Offeror should use this information when proposing hours and costs for its provider audit and reimbursement activities.

January 10, 2019 Page &P of &N

Facilities by Type

Attachment J.23.A

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS AUDIT & REIMBURESMENT (A&R) TABLES

RFP # 75FCMC19R0023

Facilities Population by Type Tables (3-6) referenced in Attachment J.23 - Government Provided Proposal Assumptions

		JE PROVIDER POPULATION BY TYPE OF FACILITIES:
		JE Freestanding Providers
	FISS Type	Description	No. of Facilities
TABLE 3		HOSPITALS:
	00	Short Term Facility-PPS Hospital	287
	02	Long Term Care Hospital	13
	03	Psychiatric Hospital	49
	04	Rehabilitation Hospital	9
	04	Rehabilitation Facility	1
	05	Pediatric Hospital	13
	07	Rural Referral Center	4
	08	Indian Health Service	0
	13	Cancer Hospital	2
	14	Medicare Dependent Hospital	1
	15	Medicare Dependent Hospital/Referral Center	0
	16	Re-based Sole Community Hospital	16
	17	Re-based Sole Community Hospital/Referral Center	3
	18	Medical Assitance Facility	0
	21	Essential Access Community Hospital	0
	22	Essential Access Community Hospital/Referral Center	0
	23	Rural Primary Care Hospital	0
	37	Critical Access Hospital	52
	43	Religious Non-Medical Health Care Institutions
		Total Hospitals	450

TABLE 4		OTHER FACILITIES:
	35	Hospice	0
	36	Home Health Agency	0
	38	Skilled Nursing Facility	1397
	41	Independent ESRD Facility	834
	42	Federally Qualified Health Centers	706
	44	Rural Health Clinics-Freestanding	44
	45	Rural Health Clinics-Provider Based	1
	46	Comprehensive Outpatient Rehab Facilities	28
	47	Community Mental Health Centers	15
	48	Outpatient Physical Therapy Services	151
	CB 01	Hospital	3
	CB 16	Renal Dialysis Facility (ESRD) (OUTPTNT)	5
	STAR 18	Home Office	136
	STAR 24	Limited Purpose Insurance Companies	4
		Total Other Facilities	3,324

TABLE 5 TOTAL FREESTANDING FACILITIES 3,774

TABLE 6		JE Hospital Based Subproviders
	FISS Type	Description	No. of Facilities
		Subproviders:
	35	Hospice	45
	36	Home Health Agency	77
	38	Skilled Nursing Facility	118
	40	Hospital Based ESRD Facility	43
	42	Federally Qualified Health Centers	7
	44	Rural Health Clinics-Freestanding	2
	45	Rural Health Clinics-Provider Based	172
	46	Comprehensive Outpatient Rehab Facilities	1
	49	Psychiatric Distinct Part Unit	65
	50	Rehabilitation Distinct Part Unit	71
	51	Short-Term Hospital - Swing Bed	12
	52	Long-Term Hospital - Swing Bed	0
	53	Rehabilitation Facility - Swing Bed	0
	54	Critical Access Hospital - Swing Bed	48
	STAR 15	Other Long Term Care Facility	0
		Total Subproviders	661

January 10, 2019 Page &P of &N

Facilities by State

Attachment J.23.A

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS AUDIT & REIMBURESMENT (A&R) TABLES

RFP # 75FCMC19R0023

Facilities by State Tables (7-8) referenced in Attachment J.23 - Government Provided Proposal Assumptions

JURISDICTION E FACILITIES BY STATE

	TABLE 7													Facilities Within Jurisdiction:
		STATES	Short Term Facility - FISS 00	LTCH- FISS 02	IPF -
FISS 03	IRF -
FISS 04	Childrens- FISS 05	Rural Referral Center - FISS 07	Cancer Hospital - FISS 13	Medicare Dependent Hospital- FISS 14	Re-based SCH - FISS 16	Re-based SCH/RRC - FISS 17	Critical Access Hospital - FISS 37	Total Hospitals		Home Office	Hospice - FISS 35	HHA - FISS 36	SNF - FISS 38	Hospital Based ESRD - FISS 40	Independent ESRD -
FISS 41	FQHC - FISS 42	RHC Freestanding - FISS 44	RHC Provider Based - FISS 45	CORF -
FISS 46	CMHC - FISS 47	OPT - FISS 48	Psych DPU - FISS 49	Rehab DPU - FISS 50	Short Term Swing Bed - FISS 51	CAH Swing Bed - FISS 54	CB 01 - Hospital	CB 16 - ESRD Outpatient	LPIC	Total Other		Total Facilities
		California	262	8	40	5	11	4	2	1	10	2	32	377		23	42	66	1,079	40	452	664	41	158	20	13	141	57	67	10	30	0	0	0	2,903	3,280
		Hawaii	7	1	1	1	2	0	0	0	5	0	9	26		0	0	6	38	0	25	29	4	3	0	0	3	3	0	2	8	0	0	0	121	147
		Nevada	14	4	8	4	0	0	0	0	1	1	11	43		1	3	5	33	0	40	20	1	12	9	2	5	5	4	0	10	0	0	0	150	193
		Guam	1	0	0	0	0	0	0	0	0	0	0	1		0	0	0	1	1	1	0	0	0	0	0	0	0	0	0	0	1	4	0	8	9
		Northern Mariana Islands	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	1	0	0	0	0	0	0	1	0	0	0	0	1	1	0	4	4
		American Samoa	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	1	0	0	2	2

	TABLE 8													Facilities Out of Jurisdiction:
		STATES	Short Term Facility - FISS 00	LTCH- FISS 02	IPF -
FISS 03	IRF -
FISS 04	Childrens- FISS 05	Rural Referral Center - FISS 07	Cancer Hospital - FISS 13	Medicare Dependent Hospital- FISS 14	Re-based SCH - FISS 16	Re-based SCH/RRC - FISS 17	Critical Access Hospital - FISS 37	Total Hospitals		Home Office	Hospice - FISS 35	HHA - FISS 36	SNF - FISS 38	Hospital Based ESRD - FISS 40	Independent ESRD -
FISS 41	FQHC - FISS 42	RHC Freestanding - FISS 44	RHC Provider Based - FISS 45	CORF -
FISS 46	CMHC - FISS 47	OPT - FISS 48	Psych DPU - FISS 49	Rehab DPU - FISS 50	Short Term Swing Bed - FISS 51	CAH Swing Bed - FISS 54	CB 01 - Hospital	CB 16 - ESRD Outpatient	LPIC	Total Other		Total Facilities
		Alabama	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15	15
		Arizona	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	10	0	6	0	0	0	0	0	0	0	0	0	0	0	0	0	16	16
		Arkansas	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	16	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16	16
		Colorado	1	0	0	0	0	0	0	0	0	0	0	1		0	0	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	15	16
		Connecticut	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	3	0	0	0	0	0	0	0	0	0	0	0	0	0	3	3
		District of Columbia	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	1	1
		Florida	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	31	0	0	0	0	0	0	0	0	0	0	0	0	0	31	31
		Georgia	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	13	0	13	0	0	0	0	0	0	0	0	0	0	0	0	0	26	26
		Idaho	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	6	0	0	0	0	0	0	0	0	0	0	0	0	0	6	6
		Illinois	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	2	0	11	0	0	0	0	0	0	0	0	0	0	0	0	0	13	13
		Indiana	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	23	0	11	0	0	0	0	0	0	0	0	0	0	0	0	0	34	34
		Kansas	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	22	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	23	23
		Kentucky	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	8	0	7	0	0	0	0	0	0	0	0	0	0	0	0	0	15	15
		Louisiana	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	4	0	0	0	0	0	0	0	0	0	0	0	0	4	8	8
		Maryland	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	4	0	8	0	0	0	0	0	0	0	0	0	0	0	0	0	12	12
		Massachusetts	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	18	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18	18
		Michigan	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	18	0	0	0	0	0	0	0	0	0	0	0	0	0	18	18
		Minnesota	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	26	0	30	0	0	0	0	0	1	0	0	0	0	0	0	0	57	57
		Mississippi	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	10
		Missouri	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	16	0	4	0	0	0	0	0	0	0	0	0	0	0	0	0	20	20
		Nebraska	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	22	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22	22
		New Jersey	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	1	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	2	2
		New Mexico	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	2	0	0	0	0	0	0	0	0	0	0	0	0	0	2	2
		New York	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	10	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	40	40
		North Dakota	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	1	1
		Ohio	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	6	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	11	11
		Oklahoma	2	0	0	0	0	0	0	0	0	0	0	2		0	0	0	0	0	6	0	0	0	0	0	0	0	0	0	0	0	0	0	6	8
		Pennsylvania	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	39	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	44	44
		South Carolina	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	7	0	0	0	0	0	0	0	0	0	0	0	0	0	7	7
		South Dakota	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	17	0	3	0	0	0	0	0	0	0	0	0	0	0	0	0	20	20
		Tennessee	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	5	0	13	0	0	0	0	0	0	0	0	0	0	0	0	0	18	18
		Texas	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	32	0	38	0	0	0	0	0	0	0	0	0	0	0	0	0	70	70
		Utah	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	7	0	3	0	0	0	0	0	0	0	0	0	0	0	0	0	10	10
		Virginia	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	13	0	18	0	0	0	0	0	0	0	0	0	0	0	0	0	31	31
		Washington	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	3	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	13	13
		West Virginia	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	3	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	4	4
		Wisconsin	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	23	0	4	0	0	0	0	0	0	0	0	0	0	0	0	0	27	27
		Home Offices	0	0	0	0	0	0	0	0	0	0	0	0		112	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112	112

TOTAL 287 13 49 10 13 4 2 1 16 3 52 450 136 45 77 1,515 43 834 713 46 173 29 15 151 65 71 12 48 3 5 4 3,985 4,435

January 10, 2019 Page &P of &N

Estimated Annual Workloads

Attachment J.23.A

GOVERNMENT PROVIDED PROPOSAL ASSUMPTIONS AUDIT & REIMBURESMENT (A&R) TABLES

RFP # 75FCMC19R0023

Estimated Annual Workloads Tables (9-26) referenced in Attachment J.23 - Government Provided Proposal Assumptions

JURISDICTION E ESTIMATED ANNUAL WORKLOADS

	FISS Type	STAR Type	Description	Work Tasks	Units
TABLE 9				Cost Report/Cost Statement Acceptance:
	00	01	Short Term Facility - PPS Hospital	Accepted-As Filed	287
	02	01	Long Term Hospital	Accepted-As Filed	13
	03	01	Psychiatric Hospital	Accepted-As Filed	49
	04	01	Rehabilitation Hospital	Accepted-As Filed	9
	05	01	Pediatric Hospital	Accepted-As Filed	13
	07	01	Rural Referral Center	Accepted-As Filed	15
	08	NA	Indian Health Service	Accepted-As Filed	- 0
	13	01	Cancer Facility	Accepted-As Filed	2
	14	01	Medicare Dependent Hospital	Accepted-As Filed	1
	15	01	Medicare Dependent Hospital/Referral Center	Accepted-As Filed	- 0
	16	01	Re-based Sole Community Hospital	Accepted-As Filed	16
	17	01	Re-based Sole Community Hospital/Referral Center	Accepted-As Filed	2
	18	01	Medical Assistance Facility	Accepted-As Filed	- 0
	21	01	Essential Access Community Hospital	Accepted-As Filed	- 0
	22	01	Essential Access Community Hospital/Referral Center	Accepted-As Filed	- 0
	23	01	Rural Primary Care Hospital	Accepted-As Filed	- 0
	35	12	Hospice	Accepted-As Filed	- 0
	36	03	Home Health Agency	Accepted-As Filed	- 0
	37	01	Critical Access Hospital	Accepted-As Filed	42
	38	02	Skilled Nursing Facility	Accepted-As Filed	1,397
	41	16	Independent ESRD Facility	Accepted-As Filed	834
	42	25	Federally Qualified Health Centers	Accepted-As Filed	196
	43	19,20	Religious Non-Medical Health Care Institutions	Accepted-As Filed	- 0
	44	04	Rural Health Clinics - Free Standing	Accepted-As Filed	36
	46	26	Comprehensive Outpatient Rehab Facilities	Accepted-As Filed	- 0
	47	26	Community Mental Health Centers	Accepted-As Filed	6
	48	17	Outpatient Physical Therapy Services	Accepted-As Filed	- 0
	NA	01	Hospital	Accepted-As Filed	3
	NA	16	Renal Dialysis Facility (ESRD) (OUTPTNT)	Accepted-As Filed	4
	NA	18	Home Office	Accepted-As Filed	123
	NA	22	OPA	Accepted-As Filed	- 0
	NA	23	Histocompatability Lab	Accepted-As Filed	- 0
	NA	24	Limited Purpose Insurance Companies	Accepted-As Filed	4
	00	01	Short Term Facility - PPS Hospital	Accepted-Amended	327
	02	01	Long Term Hospital	Accepted-Amended	- 0
	03	01	Psychiatric Hospital	Accepted-Amended	8
	04	01	Rehabilitation Hospital	Accepted-Amended	3
	05	01	Pediatric Hospital	Accepted-Amended	2
	07	01	Rural Referral Center	Accepted-Amended	3
	08	NA	Indian Health Service	Accepted-Amended	- 0
	13	01	Cancer Facility	Accepted-Amended	- 0
	14	01	Medicare Dependent Hospital	Accepted-Amended	2
	15	01	Medicare Dependent Hospital/Referral Center	Accepted-Amended	- 0
	16	01	Re-based Sole Community Hospital	Accepted-Amended	18
	17	01	Re-based Sole Community Hospital/Referral Center	Accepted-Amended	4
	18	01	Medical Assistance Facility	Accepted-Amended	- 0
	21	01	Essential Access Community Hospital	Accepted-Amended	- 0
	22	01	Essential Access Community Hospital/Referral Center	Accepted-Amended	- 0
	23	01	Rural Primary Care Hospital	Accepted-Amended	- 0
	35	12	Hospice	Accepted-Amended	- 0
	36	03	Home Health Agency	Accepted-Amended	- 0
	37	01	Critical Access Hospital	Accepted-Amended	9
	38	02	Skilled Nursing Facility	Accepted-Amended	59
	41	16	Independent ESRD Facility	Accepted-Amended	11
	42	25	Federally Qualified Health Centers	Accepted-Amended	31
	43	19,20	Religious Non-Medical Health Care Institutions	Accepted-Amended	- 0
	44	04	Rural Health Clinics - Free Standing	Accepted-Amended	6
	46	26	Comprehensive Outpatient Rehab Facilities	Accepted-Amended	- 0
	47	26	Community Mental Health Centers	Accepted-Amended	2
	48	17	Outpatient Physical Therapy Services	Accepted-Amended	- 0
	CB	01	Hospital	Accepted-Amended	1
	CB	16	Renal Dialysis Facility (ESRD) (OUTPTNT)	Accepted-Amended	1
	NA	18	Home Office	Accepted-Amended	6
	NA	22	OPA	Accepted-Amended	- 0
	NA	23	Histocompatability Lab	Accepted-Amended	- 0
	NA	24	Limited Purpose Insurance Companies	Accepted-Amended	- 0
		01		Amended-DSH provider	276
	00	01	Short Term Facility - PPS Hospital	Rejected	39
	02	01	Long Term Hospital	Rejected	- 0
	03	01	Psychiatric Hospital	Rejected	1
	04	01	Rehabilitation Hospital	Rejected	- 0
	05	01	Pediatric Hospital	Rejected	- 0
	07	01	Rural Referral Center	Rejected	- 0
	08	NA	Indian Health Service	Rejected	- 0
	13	01	Cancer Facility	Rejected	- 0
	14	01	Medicare Dependent Hospital	Rejected	- 0
	15	01	Medicare Dependent Hospital/Referral Center	Rejected	- 0
	16	01	Re-based Sole Community Hospital	Rejected	2
	17	01	Re-based Sole Community Hospital/Referral Center	Rejected	- 0
	18	01	Medical Assistance Facility	Rejected	- 0
	21	01	Essential Access Community Hospital	Rejected	- 0
	22	01	Essential Access Community Hospital/Referral Center	Rejected	- 0
	23	01	Rural Primary Care Hospital	Rejected	- 0
	35	12	Hospice	Rejected	- 0
	36	03	Home Health Agency	Rejected	- 0
	37	01	Critical Access Hospital	Rejected	2
	38	02	Skilled Nursing Facility	Rejected	15
	41	16	Independent ESRD Facility	Rejected	2
	42	25	Federally Qualified Health Centers	Rejected	6
	43	19,20	Religious Non-Medical Health Care Institutions	Rejected	- 0
	44	04	Rural Health Clinics - Free Standing	Rejected	- 0
	46	26	Comprehensive Outpatient Rehab Facilities	Rejected	- 0
	47	26	Community Mental Health Centers	Rejected	- 0
	48	17	Outpatient Physical Therapy Services	Rejected	- 0
	NA	18	Home Office	Rejected	1
	NA	22	OPA	Rejected	- 0
	NA	23	Histocompatability Lab	Rejected	- 0
	NA	24	Limited Purpose Insurance Companies	Rejected	- 0
				TOTAL	3,889

TABLE 10				Tentative Settlement
	00	01	Short Term Facility - PPS Hospital	Tentative Settlement	416
	02	01	Long Term Hospital	Tentative Settlement	13
	03	01	Psychiatric Hospital	Tentative Settlement	43
	04	01	Rehabilitation Hospital	Tentative Settlement	10
	05	01	Pediatric Hospital	Tentative Settlement	11
	07	01	Rural Referral Center	Tentative Settlement	4
	08	NA	Indian Health Service	Tentative Settlement	- 0
	13	01	Cancer Facility	Tentative Settlement	2
	14	01	Medicare Dependent Hospital	Tentative Settlement	3
	15	01	Medicare Dependent Hospital/Referral Center	Tentative Settlement	- 0
	16	01	Re-based Sole Community Hospital	Tentative Settlement	22
	17	01	Re-based Sole Community Hospital/Referral Center	Tentative Settlement	6
	18	01	Medical Assistance Facility	Tentative Settlement	- 0
	21	01	Essential Access Community Hospital	Tentative Settlement	- 0
	22	01	Essential Access Community Hospital/Referral Center	Tentative Settlement	- 0
	23	01	Rural Primary Care Hospital	Tentative Settlement	- 0
	35	12	Hospice	Tentative Settlement	- 0
	36	03	Home Health Agency	Tentative Settlement	- 0
	37	01	Critical Access Hospital	Tentative Settlement	55
	38	02	Skilled Nursing Facility	Tentative Settlement	464
	41	16	Independent ESRD Facility	Tentative Settlement	577
	42	25	Federally Qualified Health Centers	Tentative Settlement	39
	43	19,20	Religious Non-Medical Health Care Institutions	Tentative Settlement	- 0
	44	04	Rural Health Clinics - Free Standing	Tentative Settlement	17
	46	26	Comprehensive Outpatient Rehab Facilities	Tentative Settlement	- 0
	47	26	Community Mental Health Centers	Tentative Settlement	1
	48	17	Outpatient Physical Therapy Services	Tentative Settlement	- 0
	CB	01	Hospital	Tentative Settlement	4
	CB	16	Renal Dialysis Facility (ESRD) (OUTPTNT)	Tentative Settlement	5
	NA	18	Home Office	Tentative Settlement	- 0
	NA	22	OPA	Tentative Settlement	- 0
	NA	23	Histocompatability Lab	Tentative Settlement	- 0
	NA	24	Limited Purpose Insurance Companies	Tentative Settlement	- 0
				TOTAL	1,692

TABLE 11				Full Desk Reviews
	00	01	Short Term Facility - PPS Hospital	Full Desk Review @ 125 hours	26
	02	01	Long Term Hospital	Full Desk Review @ 60 hours	1
	03	01	Psychiatric Hospital	Full Desk Review @ 50 hours	3
	04	01	Rehabilitation Hospital	Full Desk Review @ 60 Hours	- 0
	05	01	Pediatric Hospital	Full Desk Review @ 60 hours	1
	07	01	Rural Referral Center	Full Desk Review	- 0
	08	NA	Indian Health Service	Full Desk Review	- 0
	13	01	Cancer Facility	Full Desk Review @ 125 hours	3
	14	01	Medicare Dependent Hospital	Full Desk Review @ 125 hours	1
	15	01	Medicare Dependent Hospital/Referral Center	Full Desk Review	- 0
	16	01	Re-based Sole Community Hospital	Full Desk Review	- 0
	17	01	Re-based Sole Community Hospital/Referral Center	Full Desk Review @ 125 hours	1
	18	01	Medical Assistance Facility	Full Desk Review	- 0
	21	01	Essential Access Community Hospital	Full Desk Review	- 0
	22	01	Essential Access Community Hospital/Referral Center	Full Desk Review	- 0
	23	01	Rural Primary Care Hospital	Full Desk Review	- 0
	35	12	Hospice	Full Desk Review	- 0
	36	03	Home Health Agency	Full Desk Review	- 0
	37	01	Critical Access Hospital	Full Desk Review @ 125 hours	31
	38	02	Skilled Nursing Facility	Full Desk Review	- 0
	41	16	Independent ESRD Facility	Full Desk Review @ 30 hours	279
	42	25	Federally Qualified Health Centers	Full Desk Review	- 0
	43	19,20	Religious Non-Medical Health Care Institutions	Full Desk Review	- 0
	44	04	Rural Health Clinics - Free Standing	Full Desk Review	- 0
	46	26	Comprehensive Outpatient Rehab Facilities	Full Desk Review	- 0
	47	26	Community Mental Health Centers	Full Desk Review	- 0
	48	17	Outpatient Physical Therapy Services	Full Desk Review	- 0
	CB	01	Hospital	Full Desk Review @ 60 hours	2
	CB	16	Renal Dialysis Facility (ESRD) (OUTPTNT)	Full Desk Review @ 30 hours	1
	NA	18	Home Office	Full Desk Review @ 50 hours	5
	NA	22	OPA	Full Desk Review	- 0
	NA	23	Histocompatability Lab	Full Desk Review	- 0
	NA	24	Limited Purpose Insurance Companies	Full Desk Review	- 0
				TOTAL	354

TABLE 12				Limited Desk Reviews
	00	01	Short Term Facility - PPS Hospital	Limited Desk Review @ 70 hours	271
	02	01	Long Term Hospital	Limited Desk Review @ 25 hours	16
	03	01	Psychiatric Hospital	Limited Desk Review @ 25 hours	52
	04	01	Rehabilitation Hospital	Limited Desk Review @ 25 hours	9
	05	01	Pediatric Hospital	Limited Desk Review @ 35 hours	6
	07	01	Rural Referral Center	Limited Desk Review @ 70 hours	5
	08	NA	Indian Health Service	Limited Desk Review	- 0
	13	01	Cancer Facility	Limited Desk Review @ 50 hours	- 0
	14	01	Medicare Dependent Hospital	Limited Desk Review	- 0
	15	01	Medicare Dependent Hospital/Referral Center	Limited Desk Review	- 0
	16	01	Re-based Sole Community Hospital	Limited Desk Review @ 70 hours	22
	17	01	Re-based Sole Community Hospital/Referral Center	Limited Desk Review @ 70 hours	2
	18	01	Medical Assistance Facility	Limited Desk Review	- 0
	21	01	Essential Access Community Hospital	Limited Desk Review	- 0
	22	01	Essential Access Community Hospital/Referral Center	Limited Desk Review	- 0
	23	01	Rural Primary Care Hospital	Limited Desk Review	- 0
	35	12	Hospice	Limited Desk Review	- 0
	36	03	Home Health Agency	Limited Desk Review	- 0
	37	01	Critical Access Hospital	Limited Desk Review @ 50 hours	15
	38	02	Skilled Nursing Facility	Limited Desk Review @ 15 hours	435
	41	16	Independent ESRD Facility	Limited Desk Review @ 10 hours	261
	42	25	Federally Qualified Health Centers	Limited Desk Review @ 25 Hours	33
	43	19,20	Religious Non-Medical Health Care Institutions	Limited Desk Review	- 0
	44	04	Rural Health Clinics - Free Standing	Limited Desk Review @ 10 hours	15
	46	26	Comprehensive Outpatient Rehab Facilities	Limited Desk Review	- 0
	47	26	Community Mental Health Centers	Limited Desk Review @ 10 hours	2
	48	17	Outpatient Physical Therapy Services	Limited Desk Review	- 0
	CB	16	Renal Dialysis Facility (ESRD) (OUTPTNT)	Limited Desk Review @ 10 hours	3
	NA	18	Home Office	Limited Desk Review @ 40 hours	- 0
	NA	22	OPA	Limited Desk Review	- 0
	NA	23	Histocompatability Lab	Limited Desk Review	- 0
	NA	24	Limited Purpose Insurance Companies	Limited Desk Review	- 0
				TOTAL	1,147

TABLE 13	Audits
	MAC Office- PPS Hospital w/DSH, GME/IME and BD @ 400 hours	15
	MAC Office- PPS Hospital w/ DSH, NAH and BD @ 400 hours	15
	MAC Office- PPS Hospital w/DSH and BD @250 hours	10
	MAC Office- Cancer Hospital w/ Cost Issues and Related Party @ 400 hours	2
	MAC Office - Critical Access Hospital @ 200 hours	4
	Provider Site- PPS Hospital w/Organ, GME/IME, DSH and NAH @450 Hrs	6
	Provider Site- PPS Hospital w/GME/IME, DSH and Bad Debts @400 Hrs	6
	Provider Site-Critical Access Hospital @ 200 hours	2
	TOTAL	60

TABLE 14				Number of Interim Rates
	00	01	Short Term Facility - PPS Hospital	Interim Rates-PIP Reviews	27
	02	01	Long Term Hospital	Interim Rates-PIP Reviews	10
	07	01	Rural Referral Center	Interim Rates-PIP Reviews	- 0
	13	01	Cancer Facility	Interim Rates-PIP Reviews	- 0
	14	01	Medicare Dependent Hospital	Interim Rates-PIP Reviews	- 0
	16	01	Re-based Sole Community Hospital	Interim Rates-PIP Reviews	2
	17	01	Re-based Sole Community Hospital/Referral Center	Interim Rates-PIP Reviews	- 0
	37	01	Critical Access Hospital	Interim Rates-PIP Reviews	8
	38	02	Skilled Nursing Facility	Interim Rates-PIP Reviews	72
	00	01	Short Term Facility - PPS Hospital	Interim Rates	455
	02	01	Long Term Hospital	Interim Rates	14
	03	01	Psychiatric Hospital	Interim Rates	46
	04	01	Rehabilitation Hospital	Interim Rates	12
	05	01	Pediatric Hospital	Interim Rates	23
	07	01	Rural Referral Center	Interim Rates	5
	08	NA	Indian Health Service	Interim Rates	- 0
	13	01	Cancer Facility	Interim Rates	6
	14	01	Medicare Dependent Hospital	Interim Rates	1
	15	01	Medicare Dependent Hospital/Referral Center	Interim Rates	- 0
	16	01	Re-based Sole Community Hospital	Interim Rates	24
	17	01	Re-based Sole Community Hospital/Referral Center	Interim Rates	4
	18	01	Medical Assistance Facility	Interim Rates	- 0
	21	01	Essential Access Community Hospital	Interim Rates	- 0
	22	01	Essential Access Community Hospital/Referral Center	Interim Rates	- 0
	23	01	Rural Primary Care Hospital	Interim Rates	- 0
	35	12	Hospice	Interim Rates	- 0
	36	03	Home Health Agency	Interim Rates	- 0
	37	01	Critical Access Hospital	Interim Rates	110
	38	02	Skilled Nursing Facility	Interim Rates	1,642
	40	16	Hospital Based ESRD Facility	Interim Rates	- 0
	41	16	Independent ESRD Facility	Interim Rates	- 0
	42	25	Federally Qualified Health Centers	Interim Rates	1,011
	43	19,20	Religious Non-Medical Health Care Institutions	Interim Rates	- 0
	44	04	Rural Health Clinics - Free Standing	Interim Rates	46
	45	04	Rural Health Clinics - Provider Based	Interim Rates	314
	46	26	Comprehensive Outpatient Rehab Facilities	Interim Rates	- 0
	47	26	Community Mental Health Centers	Interim Rates	12
	49	05	Psychiatric Distinct Part	Interim Rates	86
	50	06	Rehabilitation Distinct Part	Interim Rates	100
	51, 52, 53, 54	13, 14	Swing Beds	Interim Rates	104
	NA	01	Hospital	Interim Rates	6
	NA	22	OPA	Interim Rates	- 0
	NA	23	Histocompatability Lab	Interim Rates	- 0
				TOTAL	4,140

TABLE 15	Reimbursement Areas
	Nursing and Allied Health Education	66
	Disproportionate Share Hospital/Low Income Patients	345
	Bad Debt	1,947
	Indirect Medical Education	138
	Graduate Medical Education	126
	Organ Acquisition	22
	TOTAL	2,644

	PIP Providers
TABLE 16	PIP Providers	90
	TOTAL	90

TABLE 17	Cost Report Settlements
	Straight to Settlement	1,448
	Hospitals	432
	Other facilities	1,192
	TOTAL	3,072

TABLE 18				Reopenings
	00	01	Short Term Facility - PPS Hospital	Reopening Requests	723
	02	01	Long Term Hospital	Reopening Requests	9
	03	01	Psychiatric Hospital	Reopening Requests	4
	04	01	Rehabilitation Hospital	Reopening Requests	2
	05	01	Pediatric Hospital	Reopening Requests	7
	07	01	Rural Referral Center	Reopening Requests	23
	08	NA	Indian Health Service	Reopening Requests	- 0
	13	01	Cancer Facility	Reopening Requests	1
	14	01	Medicare Dependent Hospital	Reopening Requests	3
	15	01	Medicare Dependent Hospital/Referral Center	Reopening Requests	- 0
	16	01	Re-based Sole Community Hospital	Reopening Requests	12
	17	01	Re-based Sole Community Hospital/Referral Center	Reopening Requests	3
	18	01	Medical Assistance Facility	Reopening Requests	- 0
	21	01	Essential Access Community Hospital	Reopening Requests	- 0
	22	01	Essential Access Community Hospital/Referral Center	Reopening Requests	- 0
	23	01	Rural Primary Care Hospital	Reopening Requests	- 0
	35	12	Hospice	Reopening Requests	- 0
	36	03	Home Health Agency	Reopening Requests	- 0
	37	01	Critical Access Hospital	Reopening Requests	30
	38	02	Skilled Nursing Facility	Reopening Requests	37
	41	16	Independent ESRD Facility	Reopening Requests	1
	42	25	Federally Qualified Health Centers	Reopening Requests	- 0
	43	19,20	Religious Non-Medical Health Care Institutions	Reopening Requests	- 0
	44	04	Rural Health Clinics - Free Standing	Reopening Requests	- 0
	46	26	Comprehensive Outpatient Rehab Facilities	Reopening Requests	- 0
	47	26	Community Mental Health Centers	Reopening Requests	- 0
	48	17	Outpatient Physical Therapy Services	Reopening Requests	- 0
	CB	01	Hospital	Reopening Requests	5
	NA	18	Home Office	Reopening Requests	6
	NA	22	OPA	Reopening Requests	- 0
	NA	23	Histocompatability Lab	Reopening Requests	- 0
	NA	24	Limited Purpose Insurance Companies	Reopening Requests	- 0
				TOTAL	866

TABLE 19	Cost Report Appeals
	Preliminary Position Papers Due PRRB	178
	PRRB Live Hearings	1
	Lead MAC on Group Appeals (Review Schedule of Providers)	65
	Jurisdictional Challenges	308
	Administrative Resolutions	129
	TOTAL	681

TABLE 20		Cost Report Preliminary Position Papers by Provider Type
	00, 07, 16, 17	PPS Hospital	108
	37	Critical Access Hospital	5
	Lead MAC	Group Cases	65
		TOTAL	178

TABLE 21	Wage Index
	TOTAL Number of PPS Hospitals	311

TABLE 22	S-10 Reviews
	PPS Hospital	38

TABLE 23	HITECH
	Sub (D)-Charity Care Audits	10
	CAH-Cost and Charity Care Audits	5
	TOTAL	15

TABLE 24	File Maintenance
	PS&R	- 0
	STAR	- 0
	HCRIS	- 0
	IRIS	- 0
	Provider-Based	- 0

TABLE 25	Special Payment Status
	Provider Based Determinations	16
	TEFRA Exceptions	5
	TOTAL	21

TABLE 26			Special Audits
	41	16	End Stage Renal Dialysis 1/3 Special Audits @ 80 Hours	292

January 10, 2019 Page &P of &N

File details come from the government source that posted it. Updated Dec 28, 2023.