What is Medicare DSH?

Medicare Disproportionate Share Payments (better known as DSH) are a critical component of overall Medicare inpatient payments and help offset the costs of care hospitals incur treating indigent patients.

How is operating DSH calculated?

Medicare DSH Payment: Counting Hospital Beds & Patient Days Determine the number of beds in a hospital, according to 42 CFR Section 412.105(b), by dividing the number of available bed days during the cost reporting period by the number of days in the cost reporting period.

What is DSH revenue?

Medicaid disproportionate share hospital (DSH) payments are statutorily required payments intended to offset hospitals’ uncompensated care costs to improve access for Medicaid and uninsured patients as well as the financial stability of safety-net hospitals.

Is DSH the same as 340B?

Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment–a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients–is above 11.75%.

What is DSH adjustment?

The Medicare DSH Adjustment (42 CFR 412.106) The alternate special exception method is for large urban hospitals that can demonstrate that more than 30 percent of their total net inpatient care revenues come from State and local governments for indigent care (other than Medicare or Medicaid).

How is DSH percentage calculated?

Formula. The DSH patient percentage is the sum of two fractions meant to represent two at-risk populations: the under-served and the elderly and disabled. The Medicaid fraction consists of Medicaid eligible patient days that aren’t entitled to Medicare Part A and C divided by all total inpatient days.

What is IME payments from Medicare?

The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare’s prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations.

What is SSI ratio?

The SSI ratio, also known as the Medicare fraction, represents the percentage of patient days for beneficiaries who are eligible for both Medicare Part A and SSI. Because SSI days reside in the numerator of the Medicare fraction – the greater number of SSI days, the greater the DSH payment.

What is capital DSH?

known as the capital disproportionate share hospital (DSH) payment, for hospitals that are. known as the capital disproportionate share hospital (DSH) payment, for hospitals that are. classified as urban and have 100 or more beds.

What does DSH stand for in government?

DHS.gov. An official website of the U.S. Department of Homeland Security.

What is sub WAC pricing?

Prime Vendor Program (PVP) sub-WAC is a contracted price that allows entities subject to the GPO Prohibition who are PVP members to purchase covered outpatient drugs at a negotiated price in lieu of purchasing at the WAC price.

What is GPO prohibition?

There is a statutory prohibition against obtaining covered outpatient drugs through a group purchasing organization (GPO) or other group purchasing arrangement for disproportionate share hospitals (DSH), children’s hospitals (PED), and free-standing cancer hospitals (CAN).

What is a DSH payment from Medicaid?

Provider Payment. Medicaid disproportionate share hospital (DSH) payments are statutorily required payments intended to offset hospitals’ uncompensated care costs to improve access for Medicaid and uninsured patients as well as the financial stability of safety-net hospitals.

What is the uncompensated care payment for Medicare DSH hospitals?

Each Medicare DSH hospital will receive an uncompensated care payment based on its share of insured low income days (that is, the sum of Medicaid days and Medicare SSI days) reported by Medicare DSH hospitals. Each hospital’s uncompensated care payment is the product of three factors. These three factors are:

What are Medicaid disproportionate share hospital payments?

Medicaid disproportionate share hospital (DSH) payments are statutorily required payments intended to offset hospitals’ uncompensated care costs to improve access for Medicaid and uninsured patients as well as the financial stability of safety-net hospitals.

What is the Medicare-SSI component of the DSH payment adjustment based on?

For cost reporting periods that involve patient discharges occurring after October 1, 2004 (i.e., Federal fiscal year 2005 forward), the Medicare-SSI component of the DSH payment adjustment will be based on total patient days. Medicare-SSI ratios pursuant the CMS-1498-R2 for federal fiscal years 1988 through 2005 are available via the links below.