McKay Consulting Services Uncompensated Care

DSH Uncompensated Care

McKay Consulting Services Uncompensated Care

Under the Affordable Care Act (ACA), each provider’s calculated DSH has been reduced by 75 percent. The 75 percent reduction amount for each provider is aggregated, reduced for the percentage change in the national uninsured rate, and then is redistributed to hospitals based on each hospital’s uncompensated care costs relative to the aggregate uncompensated care costs for all DSH hospitals. While the ACA specifically cited Cost Report Worksheet S-10 as the measure of each hospital’s uncompensated care costs, until recently CMS has chosen to use “low income days” as a proxy for uncompensated care costs due to concerns relating to standardization and completeness of the Worksheet S-10 data.  Commencing with its 2018 Final Rule, CMS has informed providers that is has begun to utilize information on Cost Report Worksheet S-10 to distribute certain DSH Uncompensated Care monies.

McKay Consulting has consulted with providers regarding the proper completion of the charity and bad debt portions of Cost Report Worksheet S-10.

These services include assessments of a provider systems for accumulating information to support the Cost Report Worksheet S-10, concentrating on charity and bad debt.    In order to facilitate our Cost Report Worksheet S-10 reviews, among other things, we will/may:

  • Obtain/review charity and financial discount policies/plans
  • Obtain existing listings of charity and bad debts, and
  • Discuss and map general ledger revenue offset accounts

McKay’s efforts could also include the identification of non-covered Medicaid and other payor charges, which might be reportable in charity.

At the end of our review, we will deliver our findings and suggested enhancements for Cost Report Worksheet S-10 reporting.


Our goal is, and has always been, to provide our clients with the best finance and reimbursement consulting services in compliance with all applicable laws and regulations, while positioning providers for optimal reimbursement.

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