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Worksheet S-10 Charity and Bad Debt Listings

The purpose of this article is to provide additional information regarding Worksheet S-10 Charity and Bad Debt Listings.  Worksheet S-10 Charity and Bad Debt amounts must be supported by detailed patient listings.  The listings should contain the required data elements (reference detail below).  In addition, before listings are submitted to the MAC, they should be reviewed to ensure that inconsistencies are addressed, errors are removed, and charity charges are properly classified (reference tips below).  It is important to provide accurate listings.  This will prevent adjustments and reclassifications of amounts prior to the selection of audit samples.  In addition, it will reduce the possibility that a revised listing would need to be compiled to eliminate errors noted during an audit (which may result in the expansion of the samples or new sample selections).  The following has been prepared to assist the provider in the preparation of the S-10 listings.

The Charity listing should in Excel format and contain all of the following data elements:

  • Hospital’s Medicare Number,
  • Claim type (insured or uninsured),
  • Primary payor plan,
  • Secondary payor plan,
  • Payment Transaction Code,
  • Patient identification number (PCN),
  • Patient Name,
  • Patient’s date of birth,
  • Patient’s social security number,
  • Patient’s gender,
  • Admit date,
  • Discharge date,
  • Service indicator (hospital inpatient or outpatient),
  • Revenue code,
  • Revenue code total charges for the claim,
  • Date of write off to charity care,
  • Total patient payments for services provided,
  • Total third-party payments for services provided,
  • Patient charity contractual amount by transaction/adjustment code (this is amount of the charity care write-off),
  • Other contractual amount by transaction/adjustment code (insurance write-off, courtesy discounts, etc.),
  • Non-covered charges for days exceeding a length-of-stay limit for patients covered by Medicaid or other indigent care.

The Bad Debt listing should be in Excel format and contain all of the following data elements:

  • Hospital's Medicare Number,
  • Claim type (insured or uninsured),
  • Primary payor plan,
  • Secondary payor plan,
  • Patient identification number (PCN),
  • Patient’s date of birth,
  • Patient’s social security number,
  • Patient’s gender,
  • Patient name,
  • Admit date,
  • Discharge date,
  • Service indicator (hospital inpatient or outpatient),
  • Revenue code,
  • Revenue code total charges for the claim,
  • Date of write off to bad debt,
  • Total patient payments for the services provided,
  • Total third-party payments for services provided,
  • Patient charity contractual (write-off) amount by transaction/adjustment code,
  • Other contractual amount by transaction/adjustment code (insurance write-off, courtesy discounts, etc.),
  • Patient bad debt write-off.

Tips for Preparing S-10 Listings

Charity Listing

  1. Ensure that all requested data elements are included.
  2. Roll up activity into one line item per patient encounter.  This should be done by charity category (i.e. Insured or Uninsured).
  3. Ensure that no physician or professional services are included.
  4. Ensure all write-off dates are in the current Fiscal Year.
  5. If total charges for an item are $0, remove the item from the listing.
  6. Remove items with $0 charity care write off from the listing.
  7. Remove charity charges for claims that were reversed (positive and negative amounts cancel each other out).
  8. For each item, compare total charges to the sum of third party payments, patient payments, charity write-offs, and other contractual amounts.  Investigate and make corrections for items where the total of payments and contractual exceed total charges.
  9. Review the listing for possible duplicate entries using a unique identifier such as patient account number.  If a unique identifier is not included the listing, one can be created using a combination of other patient identifiers (CONCATENATE function).  If duplicates are noted, remove them from the listing.
  10. Uninsured Charity Write-offs – Ensure that those items with no insurance payments are properly classified as uninsured. 
  11. Insured Charity Write-offs – Ensure that those items with an insurance payment and a contractual allowance (except worker’s compensation, auto insurance, and general liability insurance) are properly classified as insured.
  12. Verify that Worker’s Compensation, Accident Liability/Auto Insurance, and General Liability Insurance that have not been paid by another carrier (including Medicare) are classified as uninsured.
  13. Verify that charity care charges are properly classified:
    1. Uninsured
      1. Uninsured Charity Care (full or partial charity write-offs);
      2. Non-covered services provided to Medicaid eligible and indigent care program patients written off to charity care (and meet charity care/financial assistance policy);
      3. Charity care for patients with coverage from an entity without a hospital contractual relationship (and meet charity care/financial assistance policy).
    2. Insured
      1. Deductibles, coinsurance, and copays under third-party coverage (public or private insurer) written off to charity care.
      2. Do not include deductibles and coinsurance claimed as Medicare bad debts.
      3. Non-covered charges for days exceeding a length-of-stay limit for patients covered by Medicaid or other indigent care programs (if included in charity care policy).
      4. Charity care for patients with coverage from an entity with a hospital contractual relationship (and meet charity care/financial assistance policy).

Bad Debt Listing

  1. Ensure that all requested data elements are included.
  2. Roll up activity into one line item per patient encounter. 
  3. Ensure that no physician or professional services are included.
  4. Ensure that all write-off dates are in the current Fiscal Year.
  5. Remove $0 bad debt items from the listing.
  6. Remove bad debts for which claims were reversed (positive and negative amounts cancel each other out).
  7. Review the listing for possible duplicate entries using a unique identifier such as patient account number.  If a unique identifier is not included the listing, one can be created using a combination of other patient identifiers (CONCATENATE function).  If duplicates are noted, remove them from the listing.

Charity and Bad Debt Listings

  1. Combine the charity and bad debt listings.
  2. Use or create a unique identifier for each item and check for duplicates.  If duplicates are noted, remove them from one of the listings.

Reviewed: 12.02.22

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