CCR Changes for A New Provider

If you are merging hospitals, your medical billing numbers may change. Provider tax identification numbers are used to identify hospitals and medical practices. When one hospital merges with another hospital, the capital cost-to-charge ratio will change for one or both hospitals in medical billing.

The first scenario in medical billing is when two hospitals merge and use one of the hospital’s tax identification number. This means that the other hospital drops their own medical billing number. When this happens, Medicare uses the hospital with the existing tax identification number to figure capital cost-to-charge ratios. The second medical billing scenario is when two hospitals merge and get a new provider number together. When neither one of the old identification numbers remain, it signifies a new hospital. In this case, Medicare uses the state capital cost-to-charge ratio average since the “new” hospital has no records.

If the hospitals do not like the ratio, they can request it to be higher or lower. However, in order for the Centers for Medicare & Medicaid Services to approve this change, there must be substantial evidence to back up their case. Medical billing must be fair for everyone, so they want to keep things honest. It is important to accurately report your capital cost-to-charge medical billing ratio. There was an instance recently in Indiana where an incorrect ratio had been charged in previous years. Now Indiana has to pay back over $3 million in over payments. That expense was probably not built into their budget.

Medical billing companies can help you keep your provider numbers and cost-to-charge ratios correct. Accuracy can mean time and money in the health care industry. Be sure your medical billing staff understand the importance of provider numbers when it comes to the cost-to-charge ratio.

View all Articles by: Melissa Clark, CCS-P