Check Your OPPS Cost-to-Charge Ratio

Dear Friends,
Attached is the CMS Program Memorandum A-03-004 that discusses updating your hospital specific outpatient PPS cost-to-charge ratio (CCR).  All hospitals will have their OPPS cost-to-charge ratios (CCR) adjusted in April 2003.  If you want your CCR adjusted earlier - because it is higher - you must request a change to AdminaStar Federal by January 30, 2003.
We recommend the following:
1) Calculate your Medicare OPPS CCR from your most recent filed cost report Worksheet D, Part V.    To calculate, divide all outpatient costs in columns 9.01 and 9.03 (for June year end providers) by outpatient charges in columns 5.01 and 5.03 (for June 2002 providers).  Exclude columns 5.02 and 9.02 as they are cost-reimbursed outpatient services.  The CMS Program Memorandum refers to the most recent tentative settled cost report, but Worksheet D Part V should be the same on the tentative and the filed report.  AdminaStar Federal should have calculated a tentative settlement on all September and December 2001 cost reports.  They may be still calculating tentative settlement the June 2002 reports.
2) Compare your current OPPS RCC against the 1996 RCC that AdminaStar is currently using.  See the other attached file titled "Sorted 1996 OPPS CCR" and look up your provider number.
3) If the results in 1) exceed 2), draft a request to AdminaStar Federal supported with your calculation from Worksheet D Part V to adjust your OPPS CCR by January 30 and your CCR request will receive priority.  If your current RCC is higher, wait until AdminaStar Federal adjusts it in April.
We strongly recommend that all hospitals review this.  These steps will take only a few minutes of your time, and if your new CCR is higher, it will favorably impact your OPPS outlier thresholds.  If you need help, please call Chris Mahler or Walt Theado at 614-430-9711 and we will walk you through the review.
MTE Consulting, Inc.
Columbus, Ohio
Program Memorandum - Adobe Acrobat File 
Sorted 1996 OPPS CRR - Excel Workbook