J.23.A GPPA Audit & Reimbursement Tables.xlsx

XLSX spreadsheet 64 KB Posted Aug 3, 2020

Attached to: Part A/Part B Medicare Administrative Contractor (MAC) Jurisdiction L (JL)
Solicitation number: 75FCMC20R0008
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

About this file

Written by GovTribe AI · Dec 27, 2023

This document provides Government Provided Proposal Assumptions (GPPA) Audit & Reimbursement Tables to support the solicitation for the Part A/Part B Medicare Administrative Contractor (MAC) Jurisdiction L contract. The tables include facility populations and estimated workloads by provider type for Delaware, Maryland, New Jersey, Pennsylvania and the District of Columbia. They specify the number and types of facilities, cost report acceptance and settlement activities, audits, reimbursement reviews, appeals, re-openings and other post-payment activities the MAC can expect for budgeting and staffing purposes. The solicitation seeks a contractor to provide specified Medicare Fee-For-Service claims processing, payment and administration services for the listed states and jurisdictions.

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Other files

File	Type	Posted
J.23 Government Provided Proposal Assumptions (GPPA) redline Amend 2.docx	DOCX document	Sep 16, 2020
J.23 Government Provided Proposal Assumptions (GPPA) clean Amend 2.docx	DOCX document	Sep 16, 2020
75FCMC20R0008 Amend 2.pdf	PDF	Sep 16, 2020
JL Solicitation 75FCMC20R0008 Sections B-M CLEAN Amend 1.pdf	PDF	Sep 4, 2020
Q and A RFP 75FCMC20R00008.xlsx	XLSX spreadsheet	Sep 4, 2020
J.34 CLIN 0001 Cost Proposal Template - Implementation clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.37 CLIN 0004 Cost Proposal Template - Option Year 2 (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.23 Government Provided Proposal Assumptions (GPPA) redline Amend 1.docx	DOCX document	Sep 4, 2020
J.48 CLIN 0015 Cost Proposal Template - Option Year 5 (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.43 CLIN 0010 Cost Proposal Template - Base Year (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.22 Basis of Estimate redline Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.22.A Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative redline Amend 1.docx	DOCX document	Sep 4, 2020
J.46 CLIN 0013 Cost Proposal Template - Option Year 3 (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.1 Statement of Work (SOW) clean Amend 1.docx	DOCX document	Sep 4, 2020
J.33 Cost Template Summary Sheet clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.21 Proposal Self-Check Tool clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.49 CLIN 0016 Cost Proposal Template - Option Year 6 (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.22.A Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative clean Amend 1.docx	DOCX document	Sep 4, 2020
JL Solicitation 75FCMC20R0008 Sections B-M REDLINE Amend 1.pdf	PDF	Sep 4, 2020
J.45 CLIN 0012 Cost Proposal Template - Option Year 2 (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.40 CLIN 0007 Cost Proposal Template - Option Year 5 (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.41 CLIN 0008 Cost Proposal Template - Option Year 6 (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.22 Basis of Estimate clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.38 CLIN 0005 Cost Proposal Template - Option Year 3 (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.42 CLIN 0009 Cost Proposal Template - Outgoing Contractor Workload Transition Activities clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.36 CLIN 0003 Cost Proposal Template - Option Year 1 (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.1 Statement of Work (SOW) redline Amend 1.docx	DOCX document	Sep 4, 2020
J.47 CLIN 0014 Cost Proposal Template - Option Year 4 (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.35 CLIN 0002 Cost Proposal Template - Base Year (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.23 Government Provided Proposal Assumptions (GPPA) clean Amend 1.docx	DOCX document	Sep 4, 2020
J.21 Proposal Self-Check Tool redline Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.39 CLIN 0006 Cost Proposal Template - Option Year 4 (PM, MIP, RAC) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
J.44 CLIN 0011 Cost Proposal Template - Option Year 1 (MPIP) clean Amend 1.xlsx	XLSX spreadsheet	Sep 4, 2020
75FCMC20R0008.pdf	PDF	Sep 4, 2020
J.37 CLIN 0004 Cost Proposal Template - Option Year 2 (PM, MIP, RAC).xlsx	XLSX spreadsheet	Aug 3, 2020
J.22.A Historic & Proposed FTE, Hours & Gross Cost Instructions & Narrative.docx	DOCX document	Aug 3, 2020
J.24 Attestations.docx	DOCX document	Aug 3, 2020
J.45 CLIN 0012 Cost Proposal Template - Option Year 2 (MPIP).xlsx	XLSX spreadsheet	Aug 3, 2020
J.10 Contractor Business Ethics COI and Compliance Program Requirements.docx	DOCX document	Aug 3, 2020
J.1.B List of Key Acronyms.docx	DOCX document	Aug 3, 2020
J.33 Cost Template Summary Sheet.xlsx	XLSX spreadsheet	Aug 3, 2020
J.35 CLIN 0002 Cost Proposal Template - Base Year (PM, MIP, RAC).xlsx	XLSX spreadsheet	Aug 3, 2020
J.42 CLIN 0009 Cost Proposal Template - Outgoing Contractor Workload Transition Activites.xlsx	XLSX spreadsheet	Aug 3, 2020
J.2 Deliverable Schedule.docx	DOCX document	Aug 3, 2020
J.1 Statement of Work (SOW) - Jurisdiction L.docx	DOCX document	Aug 3, 2020
J.7 AB MAC Award Fee Plan and Self Assessment Template.docx	DOCX document	Aug 3, 2020
J.9 Non-Disclosure Statement.docx	DOCX document	Aug 3, 2020
J.40 CLIN 0007 Cost Proposal Template - Option Year 5 (PM, MIP, RAC).xlsx	XLSX spreadsheet	Aug 3, 2020
J.43 CLIN 0010 Cost Proposal Template - Base Year (MPIP).xlsx	XLSX spreadsheet	Aug 3, 2020
J.1.A List of Key Definitions.docx	DOCX document	Aug 3, 2020

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Instructions

Attachment J.23.A

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

RFP # 75FCMC20R0008

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 (GPPA) AUDIT & REIMBURESMENT (A&R) TABLES

RFP # 75FCMC20R0008

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

		JL PROVIDER POPULATION BY TYPE OF FACILITIES:
		JL Freestanding Providers
	FISS Type	Description	No. of Facilities
TABLE 3		HOSPITALS:
	00	Short Term Facility-PPS Hospital	235
	02	Long Term Care Hospital	87
	03	Psychiatric Hospital	102
	04	Rehabilitation Hospital	21
	05	Pediatric Hospital	11
	07	Rural Referral Center	20
	08	Indian Health Service	0
	13	Cancer Hospital	1
	14	Medicare Dependent Hospital	6
	15	Medicare Dependent Hospital/Referral Center	1
	16	Re-based Sole Community Hospital	10
	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	15
	43	Religious Non-Medical Health Care Institutions	0
		Total Hospitals	512

TABLE 4		OTHER FACILITIES:
	35	Hospice	0
	36	Home Health Agency	0
	38	Skilled Nursing Facility	1521
	41	Independent ESRD Facility	438
	42	Federally Qualified Health Centers	263
	44	Rural Health Clinics-Freestanding	52
	46	Comprehensive Outpatient Rehab Facilities	36
	47	Community Mental Health Centers	17
	48	Outpatient Physical Therapy Services	255
	STAR 18	Home Office	106
	STAR 22	OPA	0
	STAR 23	Histocompatability Lab	0
	STAR 24	Limited Purpose Insurance Companies	0
		Total Other Facilities	2,688

TABLE 5 TOTAL FREESTANDING FACILITIES 3,200

TABLE 6		JL Hospital Based Subproviders
	FISS Type	Description	No. of Facilities
		SUBPROVIDERS:
	35	Hospice	22
	36	Home Health Agency	45
	38	Skilled Nursing Facility	58
	40	Hospital Based ESRD Facility	23
	42	Federally Qualified Health Centers	0
	45	Rural Health Clinics-Provider Based	44
	46	Comprehensive Outpatient Rehab Facilities	1
	48	Outpatient Physical Therapy Services	13
	49	Psychiatric Distinct Part Unit	90
	50	Rehabilitation Distinct Part Unit	70
	51	Short-Term Hospital - Swing Bed	20
	52	Long-Term Hospital - Swing Bed	0
	53	Rehabilitation Facility - Swing Bed	0
	54	Critical Access Hospital - Swing Bed	14
	STAR 15	Other Long Term Care Facility	0
		Total Subproviders	400

January 10, 2019 Page &P of &N

Facilities by State

Attachment J.23.A

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

RFP # 75FCMC20R0008

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

JURISDICTION L 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 (RRC)- FISS 07	Cancer Hospital- FISS 13	Medicare Dependent Hospital (MDH)- FISS 14	MDH/RRC- FISS 15	Re-Based Sole Community Hospital (SCH)- FISS 16	SCH/RRC- FISS 17	Critical Access Hospital- FISS 37	Total Hospitals	Hospice- FISS 35	HHA- FISS 36	Skilled Nusring Facility- FISS 38	Hospital Based ESRD- FISS 40	Independent ESRD- FISS 41	FQHC- FISS42	Freestanding RHC- FISS 44	Hopsital Based RHC- 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	Home Office- NA 18	Total Other	Total Facilities
	Delaware	4	1	5	2	1	2	0	0	0	0	0	0	15	0	2	37	2	16	10	0	0	1	0	9	1	2	0	0	1	81	96
	District of Columbia	6	2	2	1	1	0	0	0	0	0	0	0	12	0	0	16	0	9	21	0	0	0	0	5	3	1	0	0	0	55	67
	Maryland	45	2	6	1	2	0	0	0	0	1	0	0	57	4	7	189	5	96	45	0	0	5	4	76	0	0	2	0	7	440	497
	New Jersey	62	7	15	6	2	0	0	0	0	0	0	0	92	3	8	353	7	118	51	0	0	14	4	57	24	6	0	0	1	646	738
	Pennsylvania	98	10	23	9	4	16	1	6	1	8	3	15	194	14	24	599	9	184	136	21	44	16	6	101	54	49	18	14	6	1,295	1,489

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 (RRC)- FISS 07	Cancer Hospital- FISS 13	Medicare Dependent Hospital (MDH)- FISS 14	MDH/RRC- FISS 15	Re-Based Sole Community Hospital (SCH)- FISS 16	SCH/RRC- FISS 17	Critical Access Hospital- FISS 37	Total Hospitals	Hospice- FISS 35	HHA- FISS 36	Skilled Nusring Facility- FISS 38	Hospital Based ESRD- FISS 40	Independent ESRD- FISS 41	FQHC- FISS42	Freestanding RHC- FISS 44	Hopsital Based RHC- 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 52	Home Office- NA 18	Total Other	Total Facilities
	Alabama	0	1	0	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1
	Alaska	0	0	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1
	Arizona	0	2	2	0	0	0	0	0	0	0	0	0	4	0	0	2	0	0	0	0	0	0	0	0	0	0	0	0	0	2	6
	Arkansas	0	2	4	0	0	0	0	0	0	0	0	0	6	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	1	7
	California	4	0	1	0	0	0	0	0	0	0	0	0	5	1	1	5	0	0	0	0	0	0	0	0	1	1	0	0	0	9	14
	Colorado	0	0	1	0	0	0	0	0	0	0	0	0	1	0	0	12	0	0	0	0	0	0	0	1	0	0	0	0	0	13	14
	Connecticut	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19	0	0	0	0	0	0	0	1	0	0	0	0	0	20	20
	Florida	3	4	4	1	0	0	0	0	0	0	0	0	12	0	0	59	0	0	0	0	0	0	0	1	0	0	0	0	0	60	72
	Georgia	1	3	4	0	0	0	0	0	0	0	0	0	8	0	0	7	0	5	0	0	0	0	0	0	1	0	0	0	0	13	21
	Idaho	0	0	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1
	Illinois	0	0	5	0	0	0	0	0	0	0	0	0	5	0	0	24	0	0	0	0	0	0	0	1	0	0	0	0	0	25	30
	Indiana	0	3	4	0	0	0	0	0	0	0	0	0	7	0	0	4	0	0	0	0	0	0	0	0	0	0	0	0	0	4	11
	Iowa	0	1	0	0	0	0	0	0	0	0	0	0	1	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	10	11
	Kansas	0	3	0	0	0	0	0	0	0	0	0	0	3	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	5	8
	Kentucky	0	1	2	0	0	0	0	0	0	0	0	0	3	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3
	Louisiana	0	0	1	0	0	0	0	0	0	0	0	0	1	0	0	13	0	0	0	0	0	0	0	0	0	0	0	0	0	13	14
	Maine	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	1	1
	Massachusetts	0	0	4	0	0	0	0	0	0	0	0	0	4	0	1	32	0	0	0	0	0	0	3	2	0	0	0	0	0	38	42
	Michigan	0	7	1	0	0	0	0	0	0	0	0	0	8	0	1	10	0	0	0	0	0	0	0	1	0	0	0	0	0	12	20
	Minnesota	0	1	0	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1
	Mississippi	0	4	0	0	0	0	0	0	0	0	0	0	4	0	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	1	5
	Missouri	0	2	0	0	0	0	0	0	0	0	0	0	2	0	0	6	0	0	0	0	0	0	0	0	0	0	0	0	0	6	8
	Nebraska	0	1	0	0	0	0	0	0	0	0	0	0	1	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	10	11
	Nevada	7	1	2	0	0	0	0	0	0	0	0	0	10	0	0	11	0	0	0	0	0	0	0	0	2	5	0	0	0	18	28
	New Hampshire	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12	0	0	0	0	0	0	0	1	0	0	0	0	0	13	13
	New Mexico	0	1	0	0	0	0	0	0	0	0	0	0	1	0	0	6	0	0	0	0	0	0	0	0	0	0	0	0	0	6	7
	New York	0	0	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	1	1
	North Carolina	0	1	2	0	0	0	0	0	0	0	0	0	3	0	0	5	0	0	0	0	0	0	0	2	0	0	0	0	0	7	10
	North Dakota	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
	Ohio	0	7	1	0	0	0	0	0	0	0	0	0	8	0	0	37	0	4	0	0	0	0	0	2	0	0	0	0	0	43	51
	Oklahoma	1	4	0	0	0	0	0	0	0	0	0	0	5	0	0	4	0	0	0	0	0	0	0	0	0	1	0	0	0	5	10
	Rhode Island	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
	South Carolina	1	2	1	0	0	0	0	0	0	0	0	0	4	0	0	16	0	2	0	0	0	0	0	2	1	1	0	0	0	22	26
	South Dakota	0	1	0	0	0	0	0	0	0	0	0	0	1	0	0	1	0	0	0	0	0	0	0	0	0	0	0	0	0	1	2
	Tennessee	0	4	1	0	0	0	0	0	0	0	0	0	5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5
	Texas	2	6	3	0	0	2	0	0	0	1	0	0	14	0	0	36	0	0	0	0	0	0	0	1	2	4	0	0	0	43	57
	Utah	0	0	2	0	0	0	0	0	0	0	0	0	2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2
	Vermont	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
	Virginia	0	0	1	0	1	0	0	0	0	0	0	0	2	0	1	13	0	4	0	10	0	0	0	2	0	0	0	0	0	30	32
	Washington	1	0	1	0	0	0	0	0	0	0	0	0	2	0	0	4	0	0	0	0	0	0	0	0	1	0	0	0	0	5	7
	West Virginia	0	1	1	1	0	0	0	0	0	0	0	0	3	0	0	3	0	0	0	20	0	0	0	1	0	0	0	0	0	24	27
	Wisconsin	0	2	0	0	0	0	0	0	0	0	0	0	2	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	10	12
	Wyoming	0	0	1	0	0	0	0	0	0	0	0	0	1	0	0	2	0	0	0	0	0	0	0	0	0	0	0	0	0	2	3
	Home Offices	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91	91	91

TOTAL 235 87 102 21 11 20 1 6 1 10 3 15 512 22 45 1,579 23 438 263 52 44 37 17 268 90 70 20 14 106 3,088 3,600

January 10, 2019 Page &P of &N

Estimated Annual Workloads

Attachment J.23.A

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

RFP # 75FCMC20R0008

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

JURISDICTION L 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	235
	02	01	Long Term Hospital	Accepted-As Filed	95
	03	01	Psychiatric Hospital	Accepted-As Filed	104
	04	01	Rehabilitation Hospital	Accepted-As Filed	21
	05	01	Pediatric Hospital	Accepted-As Filed	14
	07	01	Rural Referral Center	Accepted-As Filed	20
	08	NA	Indian Health Service	Accepted-As Filed	- 0
	13	01	Cancer Facility	Accepted-As Filed	1
	14	01	Medicare Dependent Hospital	Accepted-As Filed	6
	15	01	Medicare Dependent Hospital/Referral Center	Accepted-As Filed	1
	16	01	Re-based Sole Community Hospital	Accepted-As Filed	10
	17	01	Re-based Sole Community Hospital/Referral Center	Accepted-As Filed	3
	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	16
	38	02	Skilled Nursing Facility	Accepted-As Filed	1,558
	41	16	Independent ESRD Facility	Accepted-As Filed	438
	42	25	Federally Qualified Health Centers	Accepted-As Filed	85
	43	19,20	Religious Non-Medical Health Care Institutions	Accepted-As Filed	- 0
	44	04	Rural Health Clinics - Free Standing	Accepted-As Filed	45
	46	26	Comprehensive Outpatient Rehab Facilities	Accepted-As Filed	14
	47	26	Community Mental Health Centers	Accepted-As Filed	- 0
	48	17	Outpatient Physical Therapy Services	Accepted-As Filed	- 0
	NA	18	Home Office	Accepted-As Filed	106
	NA	22	OPA	Accepted-As Filed	- 0
	NA	23	Histocompatability Lab	Accepted-As Filed	- 0
	NA	24	Limited Purpose Insurance Companies	Accepted-As Filed	- 0
	00	01	Short Term Facility - PPS Hospital	Accepted-Amended	128
	02	01	Long Term Hospital	Accepted-Amended	5
	03	01	Psychiatric Hospital	Accepted-Amended	8
	04	01	Rehabilitation Hospital	Accepted-Amended	6
	05	01	Pediatric Hospital	Accepted-Amended	3
	07	01	Rural Referral Center	Accepted-Amended	9
	08	NA	Indian Health Service	Accepted-Amended	- 0
	13	01	Cancer Facility	Accepted-Amended	- 0
	14	01	Medicare Dependent Hospital	Accepted-Amended	3
	15	01	Medicare Dependent Hospital/Referral Center	Accepted-Amended	- 0
	16	01	Re-based Sole Community Hospital	Accepted-Amended	3
	17	01	Re-based Sole Community Hospital/Referral Center	Accepted-Amended	1
	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	2
	38	02	Skilled Nursing Facility	Accepted-Amended	30
	41	16	Independent ESRD Facility	Accepted-Amended	4
	42	25	Federally Qualified Health Centers	Accepted-Amended	5
	43	19,20	Religious Non-Medical Health Care Institutions	Accepted-Amended	- 0
	44	04	Rural Health Clinics - Free Standing	Accepted-Amended	- 0
	46	26	Comprehensive Outpatient Rehab Facilities	Accepted-Amended	- 0
	47	26	Community Mental Health Centers	Accepted-Amended	- 0
	48	17	Outpatient Physical Therapy Services	Accepted-Amended	- 0
	NA	18	Home Office	Accepted-Amended	2
	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	216
	00	01	Short Term Facility - PPS Hospital	Rejected	8
	02	01	Long Term Hospital	Rejected	1
	03	01	Psychiatric Hospital	Rejected	- 0
	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	- 0
	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	- 0
	38	02	Skilled Nursing Facility	Rejected	5
	41	16	Independent ESRD Facility	Rejected	- 0
	42	25	Federally Qualified Health Centers	Rejected	1
	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	- 0
	NA	22	OPA	Rejected	- 0
	NA	23	Histocompatability Lab	Rejected	- 0
	NA	24	Limited Purpose Insurance Companies	Rejected	- 0
				TOTAL	3,212

TABLE 10				Tentative Settlement
	00	01	Short Term Facility - PPS Hospital	Tentative Settlement	363
	02	01	Long Term Hospital	Tentative Settlement	101
	03	01	Psychiatric Hospital	Tentative Settlement	112
	04	01	Rehabilitation Hospital	Tentative Settlement	27
	05	01	Pediatric Hospital	Tentative Settlement	17
	07	01	Rural Referral Center	Tentative Settlement	29
	08	NA	Indian Health Service	Tentative Settlement	- 0
	13	01	Cancer Facility	Tentative Settlement	1
	14	01	Medicare Dependent Hospital	Tentative Settlement	9
	15	01	Medicare Dependent Hospital/Referral Center	Tentative Settlement	1
	16	01	Re-based Sole Community Hospital	Tentative Settlement	13
	17	01	Re-based Sole Community Hospital/Referral Center	Tentative Settlement	4
	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	18
	38	02	Skilled Nursing Facility	Tentative Settlement	970
	41	16	Independent ESRD Facility	Tentative Settlement	295
	42	25	Federally Qualified Health Centers	Tentative Settlement	18
	43	19,20	Religious Non-Medical Health Care Institutions	Tentative Settlement	- 0
	44	04	Rural Health Clinics - Free Standing	Tentative Settlement	36
	46	26	Comprehensive Outpatient Rehab Facilities	Tentative Settlement	- 0
	47	26	Community Mental Health Centers	Tentative Settlement	2
	48	17	Outpatient Physical Therapy Services	Tentative Settlement	- 0
	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	2,016

TABLE 11				Full Desk Reviews
	00	01	Short Term Facility - PPS Hospital	Full Desk Review @ 125 hours	1
	02	01	Long Term Hospital	Full Desk Review @ 60 hours	2
	03	01	Psychiatric Hospital	Full Desk Review @ 50 hours	5
	04	01	Rehabilitation Hospital	Full Desk Review	- 0
	05	01	Pediatric Hospital	Full Desk Review	- 0
	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	- 0
	14	01	Medicare Dependent Hospital	Full Desk Review	- 0
	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	- 0
	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	13
	38	02	Skilled Nursing Facility	Full Desk Review	- 0
	41	16	Independent ESRD Facility	Full Desk Review	- 0
	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
	NA	18	Home Office	Full Desk Review	- 0
	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	21

TABLE 12				Limited Desk Reviews
	00	01	Short Term Facility - PPS Hospital	Limited Desk Review @ 70 hours	234
	02	01	Long Term Hospital	Limited Desk Review @ 25 hours	101
	03	01	Psychiatric Hospital	Limited Desk Review @ 25 hours	97
	04	01	Rehabilitation Hospital	Limited Desk Review @ 25 hours	13
	05	01	Pediatric Hospital	Limited Desk Review @ 35 hours	12
	07	01	Rural Referral Center	Limited Desk Review @ 70 hours	10
	08	NA	Indian Health Service	Limited Desk Review	- 0
	13	01	Cancer Facility	Limited Desk Review @ 70 hours	1
	14	01	Medicare Dependent Hospital	Limited Desk Review @ 70 hours	12
	15	01	Medicare Dependent Hospital/Referral Center	Limited Desk Review @ 70 hours	2
	16	01	Re-based Sole Community Hospital	Limited Desk Review @ 70 hours	10
	17	01	Re-based Sole Community Hospital/Referral Center	Limited Desk Review @ 70 hours	1
	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	1
	38	02	Skilled Nursing Facility	Limited Desk Review @ 15 hours	974
	41	16	Independent ESRD Facility	Limited Desk Review @ 10 hours	145
	42	25	Federally Qualified Health Centers	Limited Desk Review @ 10 hours	7
	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	40
	46	26	Comprehensive Outpatient Rehab Facilities	Limited Desk Review	- 0
	47	26	Community Mental Health Centers	Limited Desk Review	- 0
	48	17	Outpatient Physical Therapy Services	Limited Desk Review	- 0
	NA	18	Home Office	Limited Desk Review	- 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	1,660

TABLE 13	Audits
	MAC Office- PPS Hospital w/DSH, GME/IME & Organ @450 hours	4
	MAC Office- PPS Hospital w/DSH, GME/IME, N&AH @400 hours	15
	MAC Office- PPS Hospital w/DSH, GME/IME, Bad Debts @350 hours	15
	MAC Office- PPS Hospital w/DSH and BD @250 hours	8
	MAC Office - Critical Access Hospital @ 200 hours	1
	Provider Site- PPS Hospital w/Organ, GME/IME, DSH and NAH @450 Hrs	5
	Provider Site- PPS Hospital w/GME/IME, DSH and Bad Debts @400 Hrs	9
	Provider Site-Critical Access Hospital @ 250 hours	1
	MAC Office - Skilled Nusring Facility w/ Bad Debts @ 100 hours	5
	TOTAL	63

TABLE 14				Number of Interim Rates
	00	01	Short Term Facility - PPS Hospital	Interim Rates-PIP Reviews	44
	02	01	Long Term Hospital	Interim Rates-PIP Reviews	141
	03	01	Psychiatric Hospital	Interim Rates-PIP Reviews	2
	04	;01	Rehabilitation Hospital	Interim Rates-PIP Reviews	17
	07	01	Rural Referral Center	Interim Rates-PIP Reviews	- 0
	13	01	Cancer Facility	Interim Rates-PIP Reviews	4
	14	01	Medicare Dependent Hospital	Interim Rates-PIP Reviews	- 0
	15	01	Medicare Dependent Hospital/Referral Center	Interim Rates-PIP Reviews	3
	16	01	Re-based Sole Community Hospital	Interim Rates-PIP Reviews	3
	17	01	Re-based Sole Community Hospital/Referral Center	Interim Rates-PIP Reviews	- 0
	37	01	Critical Access Hospital	Interim Rates-PIP Reviews	- 0
	38	02	Skilled Nursing Facility	Interim Rates-PIP Reviews	3
	49	05	Psychiatric Distinct Part	Interim Rates-PIP Reviews	5
	50	06	Rehabilitation Distinct Part	Interim Rates-PIP Reviews	4
	00	01	Short Term Facility - PPS Hospital	Interim Rates	622
	02	01	Long Term Hospital	Interim Rates	171
	03	01	Psychiatric Hospital	Interim Rates	218
	04	01	Rehabilitation Hospital	Interim Rates	42
	05	01	Pediatric Hospital	Interim Rates	27
	07	01	Rural Referral Center	Interim Rates	62
	08	NA	Indian Health Service	Interim Rates	- 0
	13	01	Cancer Facility	Interim Rates	1
	14	01	Medicare Dependent Hospital	Interim Rates	13
	15	01	Medicare Dependent Hospital/Referral Center	Interim Rates	1
	16	01	Re-based Sole Community Hospital	Interim Rates	17
	17	01	Re-based Sole Community Hospital/Referral Center	Interim Rates	10
	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	27
	38	02	Skilled Nursing Facility	Interim Rates	324
	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	170
	43	19,20	Religious Non-Medical Health Care Institutions	Interim Rates	- 0
	44	04	Rural Health Clinics - Free Standing	Interim Rates	112
	45	04	Rural Health Clinics - Provider Based	Interim Rates	103
	46	26	Comprehensive Outpatient Rehab Facilities	Interim Rates	- 0
	47	26	Community Mental Health Centers	Interim Rates	7
	49	05	Psychiatric Distinct Part	Interim Rates	150
	50	06	Rehabilitation Distinct Part	Interim Rates	155
	51, 52, 53, 54	13, 14	Swing Beds	Interim Rates	44
	NA	22	OPA	Interim Rates	- 0
	NA	23	Histocompatability Lab	Interim Rates	- 0
				TOTAL	2,502

TABLE 15	Reimbursement Areas
	Nursing and Allied Health Education	105
	Disproportionate Share Hospital/Low Income Patients	293
	Bad Debt	2,016
	Indirect Medical Education	175
	Graduate Medical Education	154
	Organ Acquisition	29
	TOTAL	2,772

	PIP Providers
TABLE 16	PIP Providers	99
	TOTAL	99

TABLE 17	Cost Report Settlements
	Straight to Settlement	817
	Hospitals	531
	Other facilities	1,425
	TOTAL	2,773

TABLE 18				Reopenings
	00	01	Short Term Facility - PPS Hospital	Reopening Requests	232
	02	01	Long Term Hospital	Reopening Requests	47
	03	01	Psychiatric Hospital	Reopening Requests	18
	04	01	Rehabilitation Hospital	Reopening Requests	6
	05	01	Pediatric Hospital	Reopening Requests	3
	07	01	Rural Referral Center	Reopening Requests	8
	08	NA	Indian Health Service	Reopening Requests	- 0
	13	01	Cancer Facility	Reopening Requests	2
	14	01	Medicare Dependent Hospital	Reopening Requests	1
	15	01	Medicare Dependent Hospital/Referral Center	Reopening Requests	1
	16	01	Re-based Sole Community Hospital	Reopening Requests	3
	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	6
	38	02	Skilled Nursing Facility	Reopening Requests	28
	41	16	Independent ESRD Facility	Reopening Requests	6
	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	3
	NA	18	Home Office	Reopening Requests	- 0
	NA	22	OPA	Reopening Requests	- 0
	NA	23	Histocompatability Lab	Reopening Requests	- 0
	NA	24	Limited Purpose Insurance Companies	Reopening Requests	- 0
				TOTAL	367

TABLE 19	Cost Report Appeals
	Preliminary Position Papers Due PRRB	49
	PRRB Live Hearings	5
	Lead MAC on Group Appeals (Review Schedule of Providers)	486
	Individual Appeals	200
	Jurisdictional Challenges	10
	Administrative Resolutions	15
	TOTAL	765

TABLE 20		Cost Report Preliminary Position Papers by Provider Type
	00, 07, 16, 17	PPS Hospital	38
	37	Critical Access Hospital	- 0
	Lead MAC	Group Cases	11
		TOTAL	49

TABLE 21	Wage Index
	TOTAL Number of PPS Hospitals	275

TABLE 22	S-10 Audits
		181

TABLE 23 HITECH

TOTAL - 0

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

TABLE 25	Special Payment Status
	Provider Based Determinations	20
	TEFRA Exception Requests	- 0
	TOTAL	20

TABLE 26	ESRD Special Audits
	BBA 1/3 Audits per year	154

January 10, 2019 Page &P of &N

File details come from the government source that posted it. Updated Aug 3, 2020.