WSHA, Member Hospitals Address Under-reporting of DSH Medicaid Days

May 11, 2016

WSHA is working with the Health Care Authority (HCA) to address an issue causing a possible under-reporting of Medicaid days used on hospital Medicare cost reports. An under-reporting of days can result in  loss of Medicare disproportional share hospital (DSH) payments. A hospital member recently alerted WSHA to a discrepancy between their reported Medicaid days and the number calculated through the state’s DSH Reporting Data File process. In WSHA’s follow-up, HCA determined its process was inappropriately excluding days for labor and delivery services to patients enrolled under certain recipient aid category codes (RAC codes 1096 and 1209). Many of the days for these patients were paid by Medicaid and are eligible to be counted as Medicaid days on cost reports for DSH purposes.   While the issue is relatively small, in some cases it may result in significant additional Medicare DSH payments.  HCA has been engaged and willing to work with us to address the issue.

WSHA is continuing contact with HCA on this issue and will alert hospital CFOs via a bulletin on how HCA plans to provide validation of the additional days for cost report purposes. In the meantime, WSHA recommends hospitals include in their cost report and labor and delivery days for patients paid by Medicaid under RAC codes 1096 and 1209.  (Andrew Busz,


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