Over the past years, outpatient services provided by hospitals have grown significantly, with registrations increasing over 70% in the past 10 years.  This trend is continuing, and as it does the importance of correct reporting of these services will only increase.  Unfortunately, many preparers have difficulty in reporting some of these numbers.  This has resulted in large variances from year to year in these accounts, undermining the usefulness of the data to both the hospital and policy analysts. 

Outpatient Registrations have increased 70% over the past 10 years.  Click here to see a larger graph.

Outpatient Charges

Volume 1, Issue 6

May 2, 2006

Documents used in determining Outpatient Charges

The first document that may be used in breaking out the outpatient charges into their correct categories is the trial balance.  The preparer should be able to go through this document and find the accounts that relate to the given line in the Outpatient Charges Summary section of the HAR.  The general overview given in the previous section should be able to guide the preparer in what is expected in these specific accounts.

If for some reason, it is difficult or impossible to determine from the trial balance or other internal documents the specific outpatient charges, the Medicare Cost Report may be of use.  Worksheet C deals with computations involving cost to charge ratios, and in the course of the computations lists certain charges.  This may be useful to the preparer in finding certain specific outpatient charges. 

Whatever documents you use, make sure that if there were clinics, home health, or nursing home charges listed on page 3 of the HAR, their portion of the outpatient charges are not included in section 23.

If you are having difficulty with breaking out the specific outpatient charges please feel free to call or email MHA for assistance.

Most of the variances in outpatient accounts are not due to the lack of detail on outpatient charges, but how to correctly classify them into the correct accounts in section 23.  This occurs, for example, when certain categories are grouped in ancillary charges one year then next year they are counted in outpatient registration charges.

Account 0871, Outpatient Registration Charges, tends to be the most confusing for those who prepare the Hospital Annual Report.  What is placed in this account versus what should go into Ancillary Outpatient Charges (account 876) has been difficult to understand.  The types of charges that should go into outpatient registration charges should be those relating to some type of physical therapy, rehabilitation, or treatment.  Some examples would be respiratory therapy, speech pathology, renal dialysis, and electrocardiology.

Accounts found in Ancillary Charges are usually ones relating to medical supplies, drugs, or diagnostic tests.  Some examples of these would be diagnostic (not therapeutic) radiology, lab charges, supply accounts, and blood for transfusions.  The easiest way to arrive at the Ancillary charges is to determine the outpatient registration, emergency room, and outpatient surgery and subtract them from the total outpatient charges.  The amount remaining is the ancillary (this is auto calculated on the formset when the other lines are completed).

Emergency room and surgery charges for accounts 872 and 873 should be easier to arrive at.  Emergency room charges are simply that:  charges associated with the ER.  These amounts are usually found in specific accounts on the trail balance that are directly associated with the ER.  Outpatient Surgery charges should contain those charges relating to anesthesiology, the operating room, or recovery room.  

Hopefully with this general overview of what charges belong in which accounts, it should be easier for the preparer to accurately classify them in section 23 of the HAR.

Classifying Outpatient Charges Correctly

Examples of some of the types of charges included on certain lines.

Outpatient Registration Charges

· Physical Therapy

· Speech Pathology

· Renal Dialysis

· Cardiac Rehabilitation

Outpatient Surgery Charges

· Operating Room

· Anesthesiology

· Recovery Room

Outpatient Ancillary Charges

· Diagnostic Radiology

· Lab Charges

· Supplies and Drugs

Hospital Annual Report Newsletter

To remove your name from our mailing list, please click here.

Questions or comments? E-mail us at jpeters@mnhosptials.org or call (651) 659-1422.

 

To contact the Minnesota Department of Health with questions or comments, e-mail amy.camp@health.state.mn.us or call (651) 201-3575.

· Make sure to exclude all Home Health, Clinic, Nursing Home or other institution charges  listed out on page 3 of the HAR

· Calculate Ancillary Charges by subtracting the other outpatient charges from total charges.

· Use either the trial balance or the MCR, Worksheet  C, to determine specific outpatient charges.