Medicare DSH Reviews

Our Medicare DSH review process is a comprehensive approach to ensuring that every eligible Title XIX day has been reported with the proper verification and documentation...

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Eligibility Verification

PRS will provide quarterly, semi-annual or annual verification and documentation of Medicaid eligible days...

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DSH Process Implementation

PRS has developed an audit tested process for accumulating actual Medicaid paid and unpaid eligible days that are to be reported on the Medicare cost report...

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Medicare DSH Reviews

CMS RULINGS - HCFAR 97-2-4
Substantiation of Days Claimed

"As the intermediaries may require, hospitals are responsible for and must furnish appropriate documentation to substantiate the number of patient days claimed."

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Supporting Documentation

Federal Register 413.24(f)(5)(i)(C)
DSH MEDICAID eligible days documentation

"Therefore, effective for cost reporting periods beginning on or after October 1, 2018, for hospitals claiming a disproportionate share payment adjustment, a cost report will be rejected for lack of supporting documentation if it does not include a detailed listing of the hospital's Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the hospital's cost report. In addition, if the hospital submits an amended cost report that changes its Medicaid eligible days, the hospital must submit an amended listing or an addendum to the original listing of the hospital's Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the hospital's amended cost report."

Eligibility Verification

CMS RULINGS - HCFAR 97-2-4
hospitals burden of proof

"The hospitals bear the burden of proof and must verify with the State that a patient was eligible for Medicaid (for some covered services) during each day of the patient's inpatient hospital stay."

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Clients Testimonials

  • Director of Finance

    of a 500 bed hospital

    "I have a whole list of advantages to using PRS. I don't know why anyone would want to comb through their data on their own."

  • VP of Finance

    of a hospital health system

    "We appreciate our working relationship with PRS. I am very pleased with the work product and your responsiveness to our requests."

  • Controller

    of small independent hospital

    "I would never want to figure out the Medicaid eligibility on my own now that I see how much better PRS can do it for me."

  • HFMA
  • CMS
  • Federal Register
  • Novitas