HEALTHCARE
CMS’ PS&R Redesign Don Fry Director, Healthcare Advisory Healthcare Financial Management Association August 20, 2009 KPMG LLP
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CMS Web-Based PS&R Redesign
The Centers for Medicare and Medicaid Services (CMS) has been developing, over the past few years, a webbased PS&R tool for Intermediaries and providers to access PS&R summary and detail data files for cost report purposes and for financial analysis. CMS contracted in 2003 with CGI Federal, a large, independent government systems IT contractor, to redesign, program and implement the system.
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CMS Web-Based PS&R System
Why redesign Medicare’s PS&R system? ¾ The
Medicare PS&R “legacy” system has been in use since 1985, and has had 38 version updates in that time.
¾ The
technology, although adequate, is out-dated and cumbersome to maintain. ¾ The current system is installed on multiple mainframe computers located at various Medicare Fiscal Intermediary sites around the country.
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CMS Web-Based PS&R System
What will be the advantages of the new PS&R system? ¾A
web-based system allows direct access to data and reports by providers as well as MACs. ¾ The system and the data will reside on servers at CMS in Baltimore instead of in multiple FI locations. This will aid in timely updates and maintainability of the system. ¾ Users will be able to obtain summary or detail reports based on their specific requirements of date ranges, report types and provider numbers. ¾ Users will be able to obtain data in PDF or CSV formats. © 2008 KPMG LLP, the U.S. member firm of KPMG International, a Swiss cooperative. All rights reserved. Printed in U.S.A.
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CMS Web-Based PS&R System
What is the current status of the new PS&R system? ¾ Originally
expected to “go-live” in April, 2007. ¾ CMS postponed release of the system pending satisfactory implementation of a security front-end called IACS. ¾ CMS finally released the system for general use in February, 2009. ¾ The PS&R Redesign system will be used to file cost reports with FYE’s of 1/31/2009 and thereafter. ¾ The PS&R Legacy system will still be used for cost report with FYE’s prior to 1/31/2009. © 2008 KPMG LLP, the U.S. member firm of KPMG International, a Swiss cooperative. All rights reserved. Printed in U.S.A.
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CMS Web-Based PS&R System What is IACS? ¾ Individual
Authorized Computer Services ¾ IACS is a “gateway” security front-end to all CMS web-based systems requiring a user ID, password and profile. ¾ The profile identifies the user, systems to which they have access, provider numbers to which they have access, contact information, etc. ¾ IACS allows for provider self-registration and selfmanagement of user data. ¾ It’s enables providers to access multiple CMS webbased systems with a single log-in. © 2008 KPMG LLP, the U.S. member firm of KPMG International, a Swiss cooperative. All rights reserved. Printed in U.S.A.
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CMS Web-Based PS&R System Setting up an IACS account: ¾ Providers
can “self-register” for IACS at: • https://applications.cms.hhs.gov
¾ After
entering the “applications portal”, select “Account Management”, then “New User Registration”. ¾ Help Resources are also available at the URL link above.
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CMS Web-Based PS&R System Some things to know about IACS passwords: ¾ User
passwords must be changed every 60 days. ¾ Passwords must be 8 characters long, and contain at least 2 letters and 1 number. ¾ Letters in passwords must be mixed case – with at least one upper-case letter and one lower-case letter. ¾ Your password cannot contain your user ID. ¾ The pass word must be different from your six previous passwords. ¾ There are certain words that cannot be used within your password. © 2008 KPMG LLP, the U.S. member firm of KPMG International, a Swiss cooperative. All rights reserved. Printed in U.S.A.
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CMS Web-Based PS&R System
What does the new PS&R look like? ¾ Two
formats – PDF and CSV ¾ PDF affords better readability ¾ CSV enables importation into Excel for further analysis ¾ Much of the data remains the same, but is presented in a more logical and user-friendly format. Let’s take a look at the before and after formats!
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Legacy Report – 110 Summary
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New Report – 110 Summary
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New Report – 110 Summary – Section and Line Reorganization
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New Report – 110 Summary – Section and Line Reorganization
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Legacy PS&R Detail Report 1 P R O V I D E R S T A T I S T I C A L A N D R E I M B U R S E M E N T S Y S T E M 0PROGRAM ID: MD420501 - V37.A (SERVICE DATES > 02/27/2007 NOT INCLUDED IN LEGACY REPORTS) PAGE: 123982 SERVICE MONTH END: 01/31/06 PAYMENT RECONCILIATION REPORT RUN DATE: 06/07/07 REPORT #: OD44202 REPORT TYPE: 110 PROVIDER FYE: 12/31 INPATIENT - PART A PROVIDER: xxxxxxx xxxxxxxxxxxxxxxxx PAID DATES: 01/01/06 THRU 05/31/07 0************************************************************************************************************************************ *PATIENT CONTROL HIC MEDICARE TOT COVRD GROSS NET ------------ DEDUCTIBLES ----------* * NAME NUMBER NUMBER DAYS CHARGES REIMBURSEMENT REIMBURSEMENT CASH BLOOD COINS * ************************************************************************************************************************************ -----------------------------------------------------------------------------------------------------------------------------------Gxxxxx C 000000000000 0000000000 4 $33,861.47 $5,877.17 $4,965.17 $912.00 $.00 $.00 06 DRG CODE: 127 FROM: 12/28/05 THRU: 01/01/06 PAID DATE: 01/25/06 BILL FREQ: 1 DSCHRG-PATNT STATUS:YES HSP: $.00 FSP: $5,064.26 DSH: $276.51 IME (AFTER 9/88): $51.70 0REVENUE CODES : 0206 4 $5,364.00 0250 65 $2,389.27 0251 19 $495.00 0252 29 $1,955.75 0255 1 $159.00 0258 3 $190.50 0259 20 $604.50 0271 1 $7.80 0272129 $2,097.15 0300 1 $19.25 0301 22 $6,370.75 0302 3 $324.25 0305 7 $1,403.75 0306 2 $420.50 0324 2 $417.00 0352 1 $2,966.75 0390 1 $245.25 0410 22 $3,948.00 0420 3 $467.50 0450 6 $3,003.00 0730 3 $1,012.50 DRG WGHT: 1.0345 DSCHG FRCTN: 1.0000 DSCHG WGHT FRCTN: 1.0345 (CAPITAL) PYMNT: $484.70 HSP: $.00 FSP: $463.37 OUTLR: $.00 DSH ADJ: $18.72 $2.61 EXCPTONS: $.00 HOLD HARM: $.00 IME-ADJ : $.00 CAPITAL PAY CODE: B B-FSP: $463.37 B-OUTLR: -----------------------------------------------------------------------------------------------------------------------------------Hxxxxx G 0xxxxxxxxxxx xxxxxxxxxx 8 $58,645.20 $7,076.46 $6,164.46 $912.00 $.00 $.00 03 DRG CODE: 014 FROM: 12/24/05 THRU: 01/01/06 PAID DATE: 01/24/06 BILL FREQ: 1 DSCHRG-PATNT STATUS:YES HSP: $.00 FSP: $6,097.68 DSH: $332.93 IME (AFTER 9/88): $62.25 0258 43 $3,804.30 0REVENUE CODES : 0206 8 $10,728.00 0250 43 $927.32 0251 28 $4,367.25 0252 28 $2,147.75 0259 58 $1,073.00 0272235 $3,689.08 0300 1 $19.25 0301 10 $3,040.25 0305 16 $2,409.75 $417.00 0351 1 $1,795.75 0306 3 $705.25 0307 1 $236.25 0320 1 $326.50 0324 2 0370 1 $851.75 0420 13 $1,697.75 0430 7 $1,037.75 0440 7 $3,440.75 0450 3 $1,061.50 0480 3 $5,143.50 0611 1 $2,791.75 0710 1 $1,149.00 0730 3 $1,012.50 0750 2 $3,274.75 0921 1 $1,497.50 DRG WGHT: 1.2456 DSCHG FRCTN: 1.0000 DSCHG WGHT FRCTN: 1.2456 $22.54 (CAPITAL) PYMNT: $583.60 HSP: $.00 FSP: $557.92 OUTLR: $.00 DSH ADJ: $3.14 EXCPTONS: $.00 HOLD HARM: $.00 IME-ADJ : B-FSP: $557.92 B-OUTLR: $.00 CAPITAL PAY CODE: B
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New PS&R Detail Report – PDF File
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New PS&R Detail Report – CSV File
CSV File opened in default Excel format
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CMS Web-Based PS&R – Report Request Process Request a summary report by entering report parameters in a sequence of Web pages:
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CMS Web-Based PS&R System
¾ Summary
Reports can be requested on-line by the provider and will be returned to their system in-box. This file can then be saved to the provider’s local hard drive or server for further review and analysis.
¾ Detail
Reports (with PHI data) can be ordered on-line, but must be mailed to the authorized provider contact on a password protected CD-Rom by the MAC. ¾ NOTE: Only providers have access to this system at the present time, not chains or consultants.
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CMS Web-Based PS&R System – In-Box Click a column heading to sort reports by that column
Delete unwanted reports
Displays a list of all reports that have been submitted for processing. If there are no reports, “There are no results to view at this time” message appears.
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CMS Web-Based PS&R System
¾ Reports
should be deleted from the in-box after saving to hard drive or server. Reports not deleted after 21 days will be automatically deleted by the system. These can however be reordered at any time.
¾ Use
parameter criteria for zeroing in on needed data, don’t “order everything”. Select based on report types, dates, provider numbers and formats.
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CMS Web-Based PS&R System
¾ CMS
will be providing training in use of the system. This may entail web-based training or live sessions conducted by MACs. ¾ On-line Help system steps you through the process, and should be able to answer most of your questions.
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CMS Web-Based PS&R System
¾ Per
CMS, turn-around time for processing detail reports for FI/MACs should be within 30 days, although the actual turn-around time “will depend on the individual request and the current workload of the contractor.“ ¾ Detail reports in PDF format are limited to 500 pages. Larger reports will be processed as CSV files. ¾ Also per CMS, providers may request one detail report (including subunits) per fiscal year for cost report purposes at no charge. Requests for multiple years or any other request of detail data reports “are considered Special Requests and are outside of normal business and thus there will be a charge.” © 2008 KPMG LLP, the U.S. member firm of KPMG International, a Swiss cooperative. All rights reserved. Printed in U.S.A.
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CMS Web-Based PS&R System
Who do I contact if I have questions or problems? ¾ CMS
has established an External User Services (EUS) Help Desk to assist users with IACS issues. •
[email protected] • 1-866-484-8049 ¾ Questions regarding PS&R reports or the data contained within them should be directed to your Fiscal Intermediary/Medicare Administrative Contractor.
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CMS Web-Based PS&R System
Helpful CMS links for more information: − http://www.cms.hhs.gov/psrr/ − http://www.cms.hhs.gov/IACS − http://www.cms.hhs.gov/psrr/downloads/Registration_Tips_Providers.pdf − http://www.cms.hhs.gov/psrr/downloads/User_Manual_Providers.pdf − http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf − http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf − http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0754.pdf
Providers will access the web based PS&R using the following URL − https://psr-ui.cms.hhs.gov/psr-ui
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CMS Web-Based PS&R System
To receive an email copy of this presentation, send an email request :
[email protected] A copy of this presentation will also be available on the chapter website for easy access.
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CMS Web-Based PS&R System
● Are there any questions?
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