Ancillary services means the services for which charges are customarily made in addition to routine services.
Apportionment means an allocation or distribution of allowable cost between the beneficiaries of the Medicare program and other patients.
Average cost per diem for general routine services means the following:
Average cost per diem for hospital intensive care type units means the amount computed by dividing the total allowable costs for routine services in each of these units by the total number of inpatient days of care furnished in each of these units.
Average per diem private room cost differential means the difference in the average per diem cost of furnishing routine services in a private room and in a semi-private room. (This differential is not applicable to hospital intensive care type units.) (The method for computing this differential is described in paragraph (c) of this section.)
Charges means the regular rates for various services that are charged to both beneficiaries and other paying patients who receive the services. Implicit in the use of charges as the basis for apportionment is the objective that charges for services be related to the cost of the services.
Intensive care type inpatient hospital unit means a hospital unit that furnishes services to critically ill inpatients. Examples of intensive care type units include, but are not limited to, intensive care units, trauma units, coronary care units, pulmonary care units, and burn units. Excluded as intensive care type units are postoperative recovery rooms, postanesthesia recovery rooms, maternity labor rooms, and subintensive or intermediate care units. (The unit must also meet the criteria of paragraph (d) of this section.)
Nursing facility (NF)-type services, formerly known as ICF and SNF-type services, are routine services furnished by a swing-bed hospital to Medicaid and other non-Medicare patients. Under the Medicaid program, effective October 1, 1990, facilities are no longer certified as SNFs or ICFs but instead are certified only as NFs and can provide services as defined in section 1919(a)(1) of the Act.
Skilled nursing facility (SNF)-type services are routine services furnished by a swing-bed hospital that would constitute extended care services if furnished by an SNF. SNF-type services include routine SNF services furnished in the distinct part SNF of a hospital complex that is combined with the hospital general routine service area cost center under § 413.24(d)(5) . Effective October 1, 1990, only Medicare covered services are included in the definition of SNF-type services.
Ratio of beneficiary charges to total charges on a departmental basis means the ratio of charges to beneficiaries of the Medicare program for services of a revenue-producing department or center to the charges to all patients for that center during an accounting period. After each revenue-producing center's ratio is determined, the cost of services furnished to beneficiaries of the Medicare program is computed by applying the individual ratio for the center to the cost of the related center for the period.
Routine services means the regular room, dietary, and nursing services, minor medical and surgical supplies, and the use of equipment and facilities for which a separate charge is not customarily made.
Hospital Y
Department | Charges to program beneficiaries | Total charges | Ratio of beneficiary charges to total charges | Total cost | Cost of beneficiary services |
Percent | |||||
Operating rooms | $20,000 | $70,000 | 284/7 | $77,000 | $22,000 |
Delivery rooms | 0 | 12,000 | 0 | 30,000 | 0 |
Pharmacy | 20,000 | 60,000 | 331/3 | 45,000 | 15,000 |
X-ray | 24,000 | 100,000 | 24 | 75,000 | 18,000 |
Laboratory | 40,000 | 140,000 | 284/7 | 98,000 | 28,000 |
Others | 6,000 | 30,000 | 20 | 25,000 | 5,000 |
Total | 110,000 | 412,000 | 350,000 | 88,000 |
Total inpatient days | Total cost | Average cost per diem | Program in patient days | Cost of beneficiary services | |
General routine | 30,000 | $630,000 | $21 | 8,000 | $168,000 |
Coronary care unit | 500 | 20,000 | 40 | 200 | 8,000 |
Intensive care unit | 3,000 | 108,000 | 36 | 1,000 | 36,000 |
33,500 | 758,000 | 9,200 | 212,000 | ||
Total | 300,000 |
Hospital E
Facts | Private accommodations | Semi-private accommodations | Total |
Total charges | $20,000 | $175,000 | $195,000 |
Total days | 100 | 1,000 | 1,100 |
Programs days | 70 | 400 | 470 |
Medically necessary for program beneficiaries | 20 | 20 | |
Total general routine service costs | 165,000 | ||
Average private room per diem charge ($20,000 private room charges ÷ 100 days) | 1 $200 | ||
Average semi-private room per diem charge ($175,000 semi-private charge ÷ 1,000 days) | 1 $175 |
1 Per diem.
Average per diem private room cost differential.
Average cost per diem for inpatient general routine services.
Medicare general routine service cost.
Hospital K
[Determination of cost of routine SNF-type and ICF-type services and general routine hospital services1]
Facts | Days of care | ||
General routine hospital | SNF-type | ICF-type | |
Total days of care | 2,000 | 400 | 100 |
Medicare days of care | 600 | 300 | |
Average Medicaid rate | N/A | $35 | $20 |
Total inpatient general routine service costs: $250,000 |
Calculation of cost of routine SNF-type services applicable to Medicare: | |
$35 * 300 = $10,500 | |
Calculation of cost of general routine hospital services: | |
Cost of SNF-type services: $35 * 400 | $14,000 |
Cost of ICF-type services: $20 * 100 | 2,000 |
Total | $16,000 |
Average cost per diem of general routine hospital services: | |
$250,000 - $16,000 ÷ 2,000 days = $117 | |
Medicare general routine hospital cost: | |
$117 * 600 = $70,200 | |
Total Medicare reasonable cost for general routine inpatient days: | |
$10,500 + $70,200 = $80,700 |
42 C.F.R. §413.53