Introduction

There has been an influx of questions concerning reporting of Medicare Advantage (Medicare Part C) data on the cost report.  Formerly known as Medicare+Choice, a Medicare Advantage Plan is a contract between the Plan and CMS in which the Plan is generally reimbursed on a capitated basis.  Due to this reimbursement methodology, most Medicare Advantage data is not included on the Medicare Cost Report, unless there is a specific regulation providing for reimbursement.

Question:   Bad Debts

Can we claim Medicare Advantage bad debts on the Medicare Cost Report?

No, this matter has been previously addressed in Provider Notice 05-163.  Likewise, Medicare Advantage Plans are not required to cover bad debts.  You should contact the Medicare Advantage Plan to determine if they have a reimbursement provision for their bad debts.

Question:   Indirect Medical Education (IME) & Graduate Medical Education (GME)

Will traditional Medicare Fee for Service (FFS) reimburse for IME/GME related to Medicare Advantage Beneficiaries? 

The Medicare regulations allow for IME and GME payments related to these Medicare managed care beneficiaries.  It does not provide for capital IME payments.  To claim reimbursement providers must bill the Medicare FFS program by submitting simulated claims as you would a normal FFS claim.  These simulated claims are processed and captured on PS&R Report 118, which is then utilized in completing worksheet E part A for IME and E-3 part III for GME on the Medicare cost report.

Question:  Disproportionate Share Hospital (DSH) Adjustment

Where do the beneficiaries from the Medicare Advantage Plans fall into the DSH calculation?

Medicare FFS includes the days for managed care beneficiaries who are also eligible for Medicaid in the Supplemental Security Income (SSI) percentage, as determined by CMS.  No other DSH reimbursement is made for managed care beneficiaries through the Medicare cost report. 

Assistance:

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