Medicare Compliance & Reimbursement

CCR depends on new facility's number.

Hospitals that have recently undergone a merger with another facility can control which cost-to-charge ratio their Medicare fiscal intermediary uses--to a degree.

Whether or not a merged facility gets a new provider number will affect the CCR its FI uses, according to the Centers for Medicare and Medicaid Services.
 
On one hand: If one hospital merges with another hospital, the Medicare FI will continue to use the operating and capital CCR from the hospital with the "surviving" provider number, CMS reports in an Oct. 13 Medlearn Matters article.

On the other hand: If Medicare issues the hospitals a new provider number following a merger, the FI will use the statewide average CCR because "a new provider number indicates the creation of a new hospital," CMS says in the article. Hospitals Have A Voice In CCR Choice A facility can request that its FI use a higher or lower CCR--but it must provide substantial evidence to support the request, CMS notes.

CMS' changes in FIs' CCR-calculation methods took effect Nov. 7 For more information, go to: http://www.cms.hhs.gov/medlearn/matters/mmarticles/005/MM3966.pdf.