NAVEOS Releases Analysis of CMS SSI Ratio Implications for 340B Eligibility and PPS Payment Levels

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NAVEOS released an analysis today of the newly published CMS SSI ratios. This analysis includes implications of these ratios for eligibility for 340B and PPS payment levels. The announcement also addresses how hospitals affected negatively by the new information can seek to remediate the situation.

The CMS news flash includes the anticipated timeframe for settlement of open (and re-opened) Medicare cost reports for 2006-2009, how to obtain supporting data for SSI calculations, the realignment process for SSI values, and how to populate the Provider Specific File (PSF) properly.

The NAVEOS analysis includes implications of this information on the Medicare Part A cash flow for DSH hospitals, how to determine financial impact, and how to challenge the CMS numbers. The process and value of SSI re-alignment for hospitals is also described, and other implications of the delay and subsequent release of the SSI ratios.

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Robert Gricius, Founder and CEO of NAVEOS, explains “We are a long way from finally addressing this issue although it is useful to have this guidance from CMS on the timeframe for cost report adjudication. It is important that all providers understand their rights to challenge and re-compute the SSI Ratio from a concurrent and retrospective viewpoint. Acquisition of the detail records that underlie the SSI Ratio calculation is the first step in this process and I strongly recommend that all providers complete the request letter and Data Use Agreement in the near future to obtain this critical information.”

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Mike Sabo, VP of Regulatory Affairs, adds “We need to stay on top of this the process as to ensure that the industry is properly compensated for the services the hospitals have provided. The provider community must weigh all there options including determining if the SSI data is correct and whether to request a data period change from the federal fiscal year to the hospitals cost report year. Obtaining the necessary data, and supporting documentation to make this determination, could provide additional payments to your facility.”

Corporate Summary
About NAVEOS – Founded by industry veteran Robert Gricius, NAVEOS is a Healthcare Data Analytics company that focuses on maximizing past, present and future government reimbursement streams for hospitals and other healthcare organizations throughout the United States.

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Mike Sabo
NAVEOS
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