Provider reimbursement is now distributed to hospitals based on their percentage of uncompensated care reported on worksheet S-10. CMS changed the distribution of reimbursement from a low-income model to an uncompensated care model. Hospitals will continue to receive 25% of their “empirically justified” DSH reimbursement under the traditional formula. For FY 2018, CMS will distribute the remaining 75% uncompensated care pool (75% less adjustments for the change in uninsured) based on a factor of the hospitals’ low-income days (SSI + Medicaid days) and Worksheet S-10 uncompensated care costs, per Line 30.  For FY 2019, CMS will continue this methodology and use Worksheet S-10 for two-thirds of Factor 3 to distribute uncompensated care payments.  Ultimately, we think CMS will distribute the uncompensated care pool using data solely from cost report worksheet S-10 beginning in FY2020.
Worksheet S-10 is also being used by some States as transition to the use of worksheet S-10 to determine Medicaid supplemental waivers.
SCA's Worksheet S-10 Uncompensated Care Service
Now that Worksheet S-10 has been adopted to distribute the Uncompensated Care pool dollars, SCA's comprehensive S-10 Uncompensated Care Compliance Program will address a provider's process for accumulating and reporting required data on Worksheet S-10.  SCA's S-10 compliance program encompasses, but is not limited to: 
  • a review of the provider's bad debt policy
  • a review of the provides's self-pay discount policy
  • an analysis comparing/contrasting the provider's policies to program reporting requirements for Worksheet S-10
  • a review of the process of recording the applicable write-off transactions through the patient accounting and general ledger systems for compliance to established policies and procedures

Ultimately, SCA will prepare the provider's Worksheet S-10 for filing with its MAC along with supporting patient level detail needed for an acceptable cost report submission and future recommendations, if any, including the identification of areas which are inconsistent with Medicare program regulations and instructions in order for the hospital to maintain ongoing compliance. SCA will also support the client through MAC audit.



For more information related to Worksheet S-10, see these resource pages designed for you and your reimbursement teams:



 2019 IPPS Proposed Rule: Cost Report Worksheet S-10 to determine Two-Thirds of Factor 3 for Uncompensated Care Payment



Worksheet S-10 2017 History and Resource Guide 



Worksheet S-10 Q&A Posted By CMS


CMS Transmittal 11 & Cost Report Worksheet S-10 Instructions


Overview of S-10 Medicare Cost Report Instructions


2018 IPPS Final Rule & "What To Do Now" Recommendations



Now that the FY 2019 IPPS final rule has been published, providers will want to evaluate what impact the final rule will have on their uncompensated care payments.  SCA is happy to provide your hospital(s) a complimentary analysis modeling your DSH/UC impacts as a result of the FY 2019 IPPS final rule. 




Contact This email address is being protected from spambots. You need JavaScript enabled to view it. to learn about our Worksheet S-10 services aimed at preparing your organization for these reimbursement changes.