DSH Dual Eligible Patients
The Medicare regulation at 42 C.F.R. §412.106(b)(4) requires that days of service for patients who are eligible for both Medicaid and Medicare Part A (dual eligible) be eliminated from the numerator of the disproportionate share (DSH) Medicaid day count. Consequently, WPS is requesting that hospital providers take steps to ensure these days of service have been eliminated.
Providers who claim DSH Medicaid days should have a system in place to identify dual eligible patient days, or they may rely on a state Medicaid agency verification system. During our audits of cost reports, we will be asking providers to describe the system they used. Regardless of the system, providers should document their efforts to determine whether Medicaid patients are eligible for Medicare Part A.
We may also be testing a sample of patients against the Common Working File (CWF) for dual eligibility, or asking providers to perform the search if they have not done so already. The testing will consist of a search of all nine CWF host sites using the patient s social security number with the suffix A". For married or widowed female patients age 65 and older, the testing will also consist of a search of all nine CWF host sites using the husband s social security number with the suffix B". If there are any matches of these social security numbers against the CWF, all days of service for which the patient was eligible for both Medicaid and Medicare Part A will be eliminated from the DSH Medicaid day count, and the sample error rate will be projected to the population.
Page Last Updated: Tuesday, 15-Jul-2008 10:35:53 CDT
