Provider reimbursement is now distributed to hospitals based on their percentage of uncompensated care reported on Medicare cost report 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 distributed 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 continued this methodology and used Worksheet S-10 for two-thirds of Factor 3 to distribute uncompensated care payments.  Based upon the FY 2020 proposed rule, CMS will distribute the uncompensated care pool using ONLY one-year of data solely from cost report worksheet S-10.
Worksheet S-10 is also being used by some States to determine Uncompensated Care pool and distribute Medicaid supplemental waiver payments such as Texas and New Mexico.
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
SCA’s submissions meet the provisions of the cost report Worksheet S-10 instructions, are in accordance with the hospital’s charity or financial assistance policies and are fully supported through any audit.  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’s dedicated S-10 team has already been engaged to complete 640 S-10 reviews for 177 hospitals nationally and has supported S-10 audits conducted by various MACs for our client hospitals.  Contact SCA at 972-732-8100 or This email address is being protected from spambots. You need JavaScript enabled to view it. to obtain our S-10 best practices guide or to learn more about our S-10 service.



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



FFY 2017 MAC Letters & Aberrant Worksheet S-10 Data



Observations from MAC Audits - Worksheet S-10



Worksheet S-10 Audits



Cost to Charge Ratio Review For Worksheet S-10 Uncompensated Care Reporting



FY19 IPPS Final Rule: Cost Report Worksheet S-10 Is Here To Stay



Worksheet S-10 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



Now that the FY 2020 IPPS proposed rule has been published, providers will want to evaluate what impact the rule will have on their Federal uncompensated care payments using either 2015 or 2017 S-10 data.  SCA is happy to provide your hospital(s) a complimentary analysis modeling your Federal UC impacts and trends as a result of the FY 2020 IPPS proposed 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.