Medicare Wage Index Occupational Mix Survey - Summary of Changes

Medicare Wage Index Occupational Mix Survey – Summary of Changes

Introduction

1. We refined the introduction to include the following statement: “Note: Do not complete this survey if you are a no/low Medicare utilization provider. Check with your fiscal intermediary/Medicare administrative contractor to confirm the status. The introduction was modified due to commenters’ recommendation.

Instructions

1. Under paragraph two, we refined the instructions to include the following statement: “In completing the survey, a hospital should apply the same methodology it uses for allocating home office and related organization costs on Worksheet S-3, Part II, and exclude from the survey such costs associated with excluded areas. If home office or related organization personnel provide only administrative services, report their wages and hours in the “All Other Occupations” category. To the extent that there are home office or related organization personnel that are engaged in nursing activities, they must be reported in the appropriate nursing subcategory.” The instructions were modified due to commenters’ recommendation.

2. Under paragraph three, we refined the instructions to include the following statement: “Additionally, hospitals should apply the methodology that is used in the wage index calculation for allocating general service salaries and hours to excluded areas. (See Step 4 of the wage index calculation in 72 FR 47320, August 22, 2007, or in the Wage Index Calculator at http://cms.hhs.gov/AcuteInpatientIPPS/.) Note that, although wage-related costs are included in the general service allocation methodology for Worksheet S-3, wage-related costs should be excluded from the general service allocation methodology for the occupational mix survey because the occupational mix survey excludes wage-related costs.” The instructions were modified due to commenters’ recommendation.

3. Under paragraph four we refined the instructions to state “Nursing personnel working in the following cost centers as used for Medicare cost reporting purposes must …” instead of “Only nursing personnel working in the following cost centers as used for Medicare cost reporting purposes may…”. The instructions were modified due to commenters’ recommendation.

4. We expanded the list of cost centers to include cost center 57 – Renal Dialysis. Commenters recommended that CMS consider including 57 (Renal Dialysis) because this cost center also utilizes a high percentage of nursing staff.

Definitions

1. Under Paid Salaries, we revised the Provider Reimbursement Manual citation. The correct citation should be “Provider Reimbursement Manual, Part II, Section 3605.2”, instead of “Provider Reimbursement Manual, Part I, Section 3605.2”.

Occupational Categories:

1. Under Registered Nurses, we refined the category to include the following statement, “Advanced practice nurses (APNs) (that is, nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists) are usually paid by Medicare under a Part B fee schedule and not the IPPS. APNs must be excluded from the survey if they are excluded from Worksheet S-3, but should be included on the survey if they are included in one of the cost centers for the survey and are included on Worksheet S-3.” The category was revised due to commenters’ recommendation.