News and Updates

Update: LA Medicaid DRG Validation due 8/31/12 – Extended 9/7/12

Posted on: August 26th, 2012 by Michael Freeman

Around August 22, 2012, all Louisiana hospitals should have received a Medicaid DRG Validation request from the Louisiana Hospital Association or LA DHH.  There is a 8/31/12 deadline for response.  If not responded to by that date, Burns Health Policy will accept their data as reported to establish hospital specific base year cost.  It is critical that we get the files forwarded to our office for our review as soon as possible.  We have a very short time period to review and identify inaccuracies that will affect the base year Medicaid Rate that is being established.

We have discovered material inaccuracies in a majority of the validation requests that we have received!  We have observed cost calculations that did not include current XIX claims paid data, exclusion of all ancillary costs and charges from the calculation, mapping issue from revenue code to unique ancillary cost centers, exclusion of all psych ancillary charges, exclusion of NICU data.

We have been in contact with Derick Leavitt at Burns Health Policy and Jennifer Stevens at LA DHH and expressed our concerns.  There is a significant amount of data that will need to be reviewed for accuracy in each validation request.   At Derick Leavitt and Jennifer Stevens request, we are also preparing a summary paper outlining our concerns for all hospitals because once the base period hospital specific costs are determined, providers may be placed into peer groups that may ultimately determine your future Medicaid Rate for years to come.  Hence, a systemic deficiency in the methodology used to determine hospital specific costs may affect all Louisiana providers.

Please forward your validation request to our office as soon as possible.

(8/30/12 Update):  Due to the aftermath of Hurricane Isaac, the due date for validation submission has been extended to 9/7/12.  We have reached out to the Cypress Audit team by requesting copies of the settled Medicaid Cost Reports that were submitted to Burns Health Policy.  We have also requested a validation letter from Burns for our clients that have not received validation letters.