What is the Disproportionate Share Hospital program?
The Disproportionate Share Hospital (DSH) Program is a Medi-Cal supplemental payment program. It was established to reimburse hospitals for some of the uncompensated care costs associated with furnishing inpatient hospital services to Medi-Cal beneficiaries and uninsured individuals.
How do you calculate disproportionate stock?
Because Hospital A is located in an urban area, has less than 100 beds, and has a DSH patient percentage of more than 20.2%, the formula for determining the Medicare DSH adjustment is: 5.88% + [. 825 x (DSH % – 20.2%)]. Urban hospitals with less than 100 beds are subject to a maximum DSH adjustment of 12%.
What is a DSH percentage?
The DSH patient percentage is equal to the sum of the percentage of Medicare inpatient days attributable to patients eligible for both Medicare Part A and Supplemental Security Income (SSI), and the percentage of total inpatient days attributable to patients eligible for Medicaid by not Medicare Part A.
How is uncompensated care calculated?
Uncompensated care is first calculated on a hospital by hospital basis. Bad debt and charity care are reported as charges in the Annual Survey. These two numbers are added together and then multiplied by the hospital’s cost-to-charge ratio, or the ratio of total expenses to gross patient and other operating revenue.
How is uncompensated care paid?
The remaining share of uncompensated care (about 20 percent) may be covered by private sources, provider charity, or possibly transferred to other payers in the health care system. While, overall, government funding offsets nearly four-fifths of provider uncompensated care costs, it does not pay for all of these costs.
What is a disproportionate share adjustment?
A payment adjustment under Medicare’s PPS for Medicaid utilization at hospitals that serve a relatively large volume of low-income patients, pregnant patients or other patients under the Medicaid program. Disproportionate share has been a continuing topic in Congress.
What is uncompensated care cost?
Uninsured people use less care than their insured counterparts, but when they do use care and cannot pay for it themselves, the cost of that care is uncompensated. Providers may absorb these costs as bad debt or tap into funding sources designed to cover some of the costs.
What does uncompensated care mean?
Health care or services provided by hospitals or health care providers that don’t get reimbursed. Often uncompensated care arises when people don’t have insurance and cannot afford to pay the cost of care.
Who bears the cost of the uninsured?
In the aggregate, we estimate that government payments to offset the cost of uncompensated care for the uninsured totaled $33.6 billion in 2017 (Figure 1 and Table 1). The federal government contributed nearly two-thirds of these payments, an estimated $21.7 billion.
Who bears the costs of uncompensated care for those who lack coverage?
The estimated $35 billion burden of uncompensated care is shared among governments and private sponsors, although ultimately individuals bear the costs of these uncompensated services as taxpayers, providers, employees, and health care consumers.
How do you calculate uncompensated care?
Calculating Uncompensated Care Costs
- Uncompensated Care Charges = Bad Debt Charges + Financial Assistance Charges.
- Cost-to-Charge Ratio = Total Expenses Exclusive of Bad Debt. Gross Patient Revenue + Other Operating Revenue.
- Uncompensated Care Costs = Uncompensated Care Charges x Cost-to-Charge Ratio.