(Medicare Claims Processing Manual)

The Medicare contractor shall notify a hospital or CMHC whenever it makes a change to its CCR.  When a CCR is changed as a result of a tentative settlement or a final settlement of the cost report, the change to the CCR can be included in the notice that is issued to each provider after a tentative or final settlement is completed.  Medicare contractors can also issue separate notification to a hospital about a change to its CCR(s).    10.11.4 - Use of CCRs in Mergers, Acquisitions, Other Ownership Changes, or Errors Related to CCRs (Rev. 1657, Issued: 12- 31-08, Effective: 01- 01-09, Implementation: 01- 05-09)  The contractors use the CCR for the surviving provider in cases of provider merger, acquisition or other such changes.   Effective for hospitals experiencing a change of ownership after January 1, 2007, that have not accepted assignment of an existing hospital's provider agreement in accordance with 42 CFR 489.18, and do not yet have a Medicare cost report, the contractor may use the default S tatewide CCR to determine cost -based payments until the hos pital has submitted its first Medicare cost report.  See 10.11.10 for the location of the Statewide CCRs and the upper limit above which the contractor must use the Statewide CCR.  For purposes of identifying a CCR for payment, Medicare contractors may apply a Statewide average to hospitals receiving a new provider number, such as hospitals converting from non- IPPS to IPPS status.  Also, for purposes of identifying a CCR for payment, hospitals receiving a new provider number may request use of a different CCR based on substantial evidence.  Use of an alternative CCR is subject to the approval of the CMS central and regional offices as discussed in 10.11.3.2.  For hospitals experiencing a change of ownership prior to January 1, 2007, the contractor should use the prior hospital's CCR.   In instances where errors related to CCRs and/or outlier payments are discovered, the Medicare contractor shall contact the CMS central office to seek further guidance.  Medicare contractors may contact the CMS central office via the address and e -mail address listed in 10.11.3.1 of this chapter.   If a cost report is reopened after final settlement and as a result of this reopening, there is a change to the CCR, Medicare contractors should contact the CMS regional and central office for further instructions.  Medicare contractors may contact the CMS central office via the address and email address listed in 10.11.3.1.  10.11.5 - New Providers and Providers with Cost Report Periods Less Than a Full Year  (Rev. 1657, Issued: 12- 31-08, Effective: 01- 01-09, Implementation: 01- 05-09)  The contractors must calculate a hospital CCR using the most recent full -year cost report if a hospital or CMHC has a short period cost report.   The contractors must use the Statewide CCR for all inclusive rate hospitals paid under OPPS, or when a new provider does not have a full years cost report and has no cost report history.   See 10.11.10 for the location of the Statewide CCRs.   10.11.6 - Substitution of Statewide CCRs for Extreme OPPS Hospi tal Specific CCRs  (Rev. 1657, Issued: 12- 31-08, Effective: 01- 01-09, Implementation: 01- 05-09)  The contractors must use the applicable Statewide average urban or rural hospital default ratio if the CCR calculated for a hospital paid under OPPS is greater than the upper limit CCR in the file of overall OPPS hospital CCR limits on the CMS Web site.   In addition to the circumstances listed in 10.11.6, 10.11.5, and 10.11.4 of this chapter, a Medicare contractor also should use a Statewide average CCR if it i s unable to determine an accurate overall ancillary CCR for a hospital for whom accurate data with which to calculate an operating CCR is not available.  Further, the policies of 10.11.3.1 and 10.11.3.2 can be applied as an alternative to the Statewide a verage.   See 10.11.10 for the location of the Statewide CCRs and the upper limit above which the contractor must use the Statewide CCR.    10.11.7 - Methodology for Calculation of Hospital Overall CCR for Hospitals That Do Not Have Nursing and Paramedical E ducation Programs for Cost Reporting Periods Beginning Before  May 1, 2010, Under Cost Report Form 2552- 96 (Rev. 2296, Issued: 09- 02-11, Effective: 10- 01-11, Implementation: 10- 03-11)  10.11.7.1 - Methodology for Calculation of Hospital Overall CCR for Hos pitals That Do Not Have Nursing and Paramedical Education Programs for Cost Reporting Periods Beginning On or After May 1, 2010, Under Cost Report 2552 -10 (Rev. 2296, Issued: 09- 02-11, Effective: 10- 01-11, Implementation: 10- 03-11)  In calculating the hosp itals costs or charges, do not include departmental CCRs and charges for services that are not paid under the OPPS such as physical, occupational and speech language therapies, clinical diagnostic laboratory services, ambulance, rural health clinic servic es, non- implantable DME, etc. See 10.11.10 for the location of the list of exact cost centers that shall be included in the calculation of the overall CCR.   Step 1 -  Determining Overall Costs:   Calculate costs for each cost center by multiplying the departmental CCR for each cost center (and subscripts thereof) that reflect services subject to the OPPS from Form CMS 2552- 10, Worksheet C, Part I, Column 9 by the Medicare outpatient charges for tha t cost center (and subscripts thereof) from Worksheet D, Part V, Columns 2, 3, and 4,. Sum the costs calculated for each cost center to arrive at Medicare outpatient cost of services subject to OPPS.   Step 2 -  Determining Overall Charges: Calculate charges by summing the Medicare outpatient charges from Form CMS 2552- 10, Worksheet D, Part V, Columns 2, 3, and 4, (and for each cost center (and subscripts thereof) that reflect services subject to the OPPS.   Step 3 -  Calculating the Overall CCR: Divide the c osts from Step 1 by the charges from Step 2 to calculate the hospitals Medicare outpatient CCR.   10.11.8 - Methodology for Calculation of Hospital Overall CCR for Hospitals That Have Nursing and Paramedical Education Programs for Cost Reporting Periods Beginning Before May 1, 2010, Under Cost Report Form 2552- 96 (Rev. 2296, Issued: 09- 02-11, Effective: 10- 01-11, Implementation: 10- 03-11)  10.11.8.1 - Methodology for Calculation of Hospital Overall CCR for Hospitals That Have Nursing and Paramedical Education Programs for Cost Reporting Periods Beginning On or After May 1, 2010, Under Cost Report 2552 -10 (Rev.  2296, Issued: 09- 02-11, Effective: 10- 01-11, Implementation: 10- 03-11)  Do not include departmental CCRs and charges for services not subject to the OPPS (such as physical, occupational and speech language therapies, clinical diagnostic laboratory services, ambulance, rural health clinic services, non -implantable DME, etc.) in calculating the hospitals costs or charges.  See 10.11.10 for the location of the list of the exact cost centers that should be included in the overall CCR.   Step 1 -- Determining  costs for each department:   From Worksheet B, Part 1 -  Column 26, deduct the nursing and paramedical education costs found on the applicable line in Columns - 20, and 23 of Worksheet B, Part I to calculate a cost for each cost center.   Exception: The costs for 9200 are not calculated on this worksheet. For cost center 9200,  Observation Beds (Non -Distinct Part), use the cost reported on Worksheet D-1, Part IV, line 89, and deduct the nursing and paramedical education costs found on Worksheet D-1, Part IV, line 93 and subscripts, column 5. See Step 3 below.   Step 2 - Determining charges for each department: From worksheet C, Part 1 - Column 8 (sum of columns 6 and 7), identify total charges.   Step 3 - Determining the CCRs for each department without nursing and paramedical education costs: For each line, divide the costs from Step1 by the charges from Step 2 to acquire CCRs for each line, without inclusion of nursing and paramedical education costs. Exception: For cost center 9200,  Observation Beds (Non -Distinct Part), use the cost reported on Worksheet D-1, Part IV, line 89, and deduct the nursing and paramedical education costs found on Worksheet D-1, Part IV, line 93 and subscripts, column 5.   Step 4 - Determining Overall Costs: Multiply the CCR in step 3 by the Medicare outpatient charges for that cost center (and subscripts thereof) from Worksheet D Part V, Columns 2, 3, and 4,. Sum the costs calculated for each cost center to arrive at Medicare outpatient cost of services subject to OPPS.   Step 5 - Determining Overall Charges: Calculate charges by summing the Medicare outpatient charges from Form CMS 2552-10, Worksheet D, Part V, Columns 2, 3, and 4, for each cost center (and subscripts thereof) that reflect service subject to the OPPS.   Step 6 - Calculating the Overall CCR: Divide the costs from Step 4 by the charges from step 5 to calculate the hospitals Medicare outpatient CCR.   10.11.9 - Methodology for Calculation of CCR for CMHCs  (Rev. 10869; Issued: 07-14-21; Effective: 08-13-21; Imp lementation: 08 -13-21)  Calculate the CMHCs CCR using the providers most recent full year cost report, Form CMS 2088-92, and Medicare cost and charges from Worksheet C, Page 2. Divide costs from line 39.01, Column 3 by charges from line 39.02, Column 3 t o calculate the CCR.   Calculate the CMHCs CCR using the providers most recent full year cost report, Form CMS 2088-17, and Medicare cost and charges from Worksheet C.  Divide costs from line 50, Column 5, by charges from line 50, Column 4, to calculate t he CCR .  If the CCR is above 1.0 enter the appropriate Statewide average urban or rural hospital default ratio that is in the OPSF for the CMHC.  There is no lower limit for CMHC CCRs.  Use the CCR you calculate and do not substitute the Statewide average urban or rural hospital default ratio in cases where the CCR is below 1.0.  Note that CCR reporting requirements in 10.11 apply to both hospitals paid under OPPS and to CMHCs.  10.11.10 - Location of Statewide CCRs, Tolerances for Use of Statewide CCRs in  Lieu of Calculated CCRs and Cost Centers to be Used in the Calculation of CCRs (Rev. 1657, Issued: 12- 31-08, Effective: 01-01-09, Implementation: 01-05-09)  The file of OPPS hospital upper limit CCRs and the file of Statewide CCRs are located on the CMS Web site at www.cms.hhs.gov/HospitalOutpatientPPS/  under Annual Policy Files.  A spreadsheet li sting the Statewide CCRs also  can be found in the file containing the preamble tables that appears in the most recent OPPS/ASC final rule.  The contractors must always use the most recent Statewide CCR.   The file of standard and nonstandard cost centers to be used in the calculation of hospital outpatient CCRs is also found on the CMS Web site at www.cms.hhs.gov/HospitalOutpatientPPS/ under Revenue Code to Cost Center Crosswalk.   10.11.11 - Reporting of CCRs for Hospitals Paid Under OPPS and for CMHCs (Rev.  2111, Issued: 12- 03-10, Effective: 04- 01-11, Implementation: 04- 04-11 )