N.Y. Comp. Codes R. & Regs. tit. 10 § 442.29

Current through Register Vol. 46, No. 53, December 31, 2024

Section 442.29 - Periodic interim payments

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(a) Periodic interim payments are made biweekly to a hospital on the PIP program and are based on the hospital's estimate of applicable Medicare reimbursement for the current cost report period. When such payments are received, a cash account in the Unrestricted Fund is debited and a-PIP Clearing Account (account 1051) is credited for the amount of the payment. When applicable Medicare charges are billed to the intermediary, the PIP Clearing Account is debited and patient accounts receivable is credited. At year-end, adjustments must be made to eliminate any remaining balance in the PIP Clearing Account and to reflect the amount receivable from, or due to, the Medicare intermediary.

(b) To illustrate these entries, assume the following facts:

(1) PIP payments during the year totaled $100,000, and applicable Medicare charges billed during the year were as follows:

Total charges	$98,000
Noncovered charges	4,000
Deductibles and coinsurance	8,000
and

(2) Applicable unbilled Medicare charges and in-house patient balances were as follows at year-end:

Total charges	$10,000
Noncovered charges	500
Deductibles and coinsurance	1,200
and

(3) Applicable reimbursable costs per the Medicare cost report prepared for the year were $92,000.

(c) In summary form, the accounting entries necessary to properly reflect the above transactions would be:

	Account	Dr.	Cr.
(1) Cash	1010	$100,000
PIP Clearing Account	1051		$100,000
To record the receipt of PIP payments during the year.
(2) Inpatient Receivables- Discharged & Unbilled	1032	108,000
Various Revenue Accounts			108,000
To record applicable Medicare revenue for the year.
(3) PIP Clearing Account	1051	86,000
Inpatient Receivables-Other	1035	12,000
Inpatient Receivables- Discharged & Unbilled	1032		98,000
To record the billing of Medicare charges to the intermediary ($86,000) and to Medicare patients for noncovered charges and deductibles and coinsurance ($12,000).
(4) PIP Clearing Account	1051	8,300
Inpatient Receivables- Discharged & Unbilled	1032		8,300
To transfer the amount of applicable unbilled Medicare receivables at year-end to the PIP Clearing Account ($10,000 - $500 - $1,200).
(5) PIP Clearing Account-Medicare	1051	5,700
Contractual Adjustments- Medicare	5910		5,700
To transfer the balance in the PIP Clearing Account at year-end to the Contractual Adjustments account (the PIP Clearing Account must be zero at year-end).
(6) Contractual Adjustments Medicare	5910	17,200
Reimbursement Settlement	2071
Due-Medicare			$17,200
To record the amount of cost report reimbursement settlement due, based upon cost report filed (total PIP payments of $100,000 and deductibles/coinsurance in the amount of $9,200, less $92,000 reimbursable inpatient costs per the cost report).

(d) Although the preceding illustration reflects year-end adjustments, similar entries should be made at the end of each month in order to properly reflect the amount of contractual adjustment during the year. In order to do this, cost reimbursement settlement must be estimated. When done at month-end, entries 4 - 6 would be reversed at the beginning of the next month.

(e) The above example adheres to the principle that, at year-end, the entire amount receivable from or payable to the intermediary by a provider under the PIP program must be reflected in account 1052.00 or 2061.00. There are no receivables "in-transit" under the PIP program. Although more complex systems of accounting for periodic interim payments and related billings are permissible-such as establishing separate subaccounts for:

(1) PIP cash received;

(2) Medicare PIP billings, including amounts unbilled at year-end; and

(3) PIP contractual allowances-this basic principle must be followed.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 442.29