Repayment ISSUES RELATED TO SWING BED CONVERSIONS

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Repayment ISSUES RELATED TO SWING BED CONVERSIONS MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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SWING BED CONVERSIONS ONLY WORK FOR CRITICAL ACCESS HOSPITALS MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAH REIMBURSEMENT SWING BED VS SKILLED NURSING HOME SWING BED – MEDICARE PAYS FULL COST BASED REIMBURSEMENT SKILLED NURSING HOME – MEDICARE PAYS RUG BASIS OF REIMBURSEMENT MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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HOWEVER MEDICARE SKILLED NH CARE REIMBURSEMENT IS NOT THE ISSUE WITH SWING BED CONVERSIONS MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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THE ISSUE WITH SWING BED CONVERSIONS IS CONVERTING UNREIMBURSED COST TO REIMBURSABLE COST MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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WHAT IS A SWING BED? A SWING BED IS A BED THAT CAN BE USED FOR: OBSERVATION BED ACUTE CARE SKILLED NURSING HOME CARE INTERMEDIATE NURSING HOME CARE MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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SWING BEDS DO NOT HAVE TO BE USED FOR ALL FOUR PURPOSES ALL THE TIME MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAN SWING BEDS BE USED FOR SHORT TERM CARE? Completely YOU HAVE ALL USED SWING BEDS FOR SHORT TERM CARE MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAN SWING BEDS BE USED FOR LONG-TERM NH CARE? Totally MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAN THE HOSPITAL SET ASIDE BEDS? Perception BED YES ACUTE CARE YES SHORT TERM SWING BED SKILLED NH CARE YES SHORT TERM SWING BED INTERMEDIATE CARE YES MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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WHY WOULD I WANT TO CONVERT LONG-TERM BEDS TO SWING? MORE MEDICARE ACUTE CARE REIMBURSEMENT MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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THE KEY TO SWING BED CONVERSIONS IS MEDICARE'S HANDLING OF NON - MEDICARE SWING BED DAYS MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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THE FOLLOWING IS A SIMPLE EXAMPLE MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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WHO QUALIFIES DAYTON YES PORT ANGELES NON-CAH SOAP LAKE NON-CAH NEWPORT YES EPHRATA ALREADY AT MAX PROSSER YES FORKS YES ODESSA YES POMEROY YES TONASKET YES REPUBLIC YES QUINCY YES DAVENPORT YES GRAND COULEE YES RENTON NON-CAH MORTON YES MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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HOW MANY BEDS SHOULD BE CONVERTED? A CRITICAL ACCESS HOSPITAL IS LIMITED TO 25 ACUTE CARE AND SWING BEDS MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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TO DETERMINE HOW MANY NH BEDS SHOULD BE CONVERTED SEVERAL QUESTIONS MUST BE ANSWERED? MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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HOW MANY ACUTE CARE BEDS DO YOU NEED TO MEET THE CURRENT DEMAND? Remember THAT BEDS USED STRICTLY FOR OUTPATIENT SERVICES DO NOT COUNT AS PART OF THE 25 BED LIMIT MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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HOW MANY SWING BEDS DO YOU ALREADY HAVE? MOST CRITICAL ACCESS HOSPITALS ALREADY HAVE EITHER 5 OR 6 SWING BEDS MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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THE MAXIMUM SWING BED CONVERSION IS 25 BEDS LESS NEEDED ACUTE CARE BEDS LESS EXISTING SWING BEDS MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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DO YOU WANT TO CONVERT THE MAXIMUM? Huge NURSING HOMES YES SMALL NURSING HOMES ? MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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FOR FACILITIES WITH SMALL NURSING HOMES A PARTIAL CONVERSION IS RECOMMENDED CONVERT ALL NURSING HOME BEDS AND PRO SHARE ELIGIBILITY MAY BE ELIMINATED MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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SMALL NURSING HOMES PARTIAL CONVERSION WEIGH GAIN FROM CONVERSION OF SOME NURSING HOME BEDS WITH AFFECT ON FUTURE PRO SHARE FUNDING MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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PRO SHARE RELATED QUESTIONS FOR SMALL NH IS PRO SHARE GOING TO CINTINUE? NO - CONVERT ALL BEDS YES – ADDITIONAL INFORMATION NEEDED MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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PRO SHARE WILL CONTINUE ADDITIONAL QUESTIONS FOR SMALL NH HOW MUCH WILL PRO SHARE BE? By what means WILL MY SHARE OF PRO SHARE BE DETERMINED EQUAL DISTRIBUTION TO ALL DISTRIBUTION BASED ON MEDICAID NH DAYS DISTRIBUTION BASED ON MEDICAID LOSS OTHER METHOD MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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PRO SHARE WILL CONTINUE DISTRIBUTION EQUAL SMALL NH SHOULD HAVE AT LEAST ONE BED MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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PRO SHARE WILL CONTINUE DISTRIBUTION BASED ON MEDICAID DAYS KEEP NH BEDS NEEDED TO ACCOMPDATE MEDICAID NH PATIENTS CONVERT THE REST TO SWING MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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PRO SHARE WILL CONTINUE DISTRIBUTION BASED ON MEDICAID LOSS KEEP NH BEDS NEEDED TO ACCOMPDATE MEDICAID NH PATIENTS CONVERT THE REST TO SWING MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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PRO SHARE WILL CONTINUE PUT PRIVATE PAY AND MEDICARE PATIENTS IN SWING BEDS KEEP MEDICAID PATIENTS IN NURSING HOME MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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WHEN PRO SHARE CHANGES REEVALUATE OPTIONS MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAPITAL PROJECTS WHAT HAPPENS WHEN YOU CONVERT NH BEDS TO SWING BEDS? BEFORE CONVERSION MEDICARE AND MEDICAID PAY FOR THEIR SHARE OF HOSPITAL CAPITAL COST BEFORE CONVERSION VERY LITTLE HELP RECEIVED FROM NH SIDE MICHAEL R. Ringer & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAPITAL PROJECTS WHAT HAPPENS WHEN YOU CONVERT NH BEDS TO SWING BEDS? AFTER CONVERSION MEDICARE AND MEDICAID PAY FOR THEIR SHARE OF HOSPITAL CAPITAL COST WHICH INCLUDE SWING BED COSTS MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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CAPITAL PROJECTS BEFORE CONVERSION MEDICARE AND MEDICAID PAY FOR 35% OF CAPTIAL PROJECT AFTER CONVERSION MEDICARE AND MEDICAID PAY FOR 55% OF CAPTIAL PROJECT MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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RECOMMENDATIONS DAYTON NO DATA PROVIDED PORT ANGELES NON-CAH SOAP LAKE NON-CAH NEWPORT PARTIAL CONVERSION – NO AFFECT ON PRO SHARE EPHRATA ALREADY AT MAX PROSSER LIMITED CONVERSION – MAXIMIZE PROSHARE FORKS NO DATA PROVIDED (CONVERSION IN PROCESS) ODESSA NO DATA PROVIDED POMEROY PARTIAL CONVERSION – NO AFFECT ON PRO SHARE TONASKET PARTIAL CONVERSION – NO AFFECT ON PRO SHARE REPUBLIC LIMITED CONVERSION – MAXIMIZE PROSHARE QUINCY LIMITED CONVERSION – MAXIMIZE PROSHARE DAVENPORT NO DATA PROVIDED GRAND COULEE LIMITED CONVERSION – MAXIMIZE PROSHARE RENTON NON-CAH MORTON LIMITED CONVERSION – MAXIMIZE PROSHARE MICHAEL R. Chime & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

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ANY QUESTIONS? MICHAEL R. Chime & COMPANY CERTIFIED PUBLIC ACCOUNTANTS & CONSULTANTS 12 E. ROWAN STE. 2 SPOKANE, WA 99207 (509)489-4524 EMAIL:bellcpa@AOL.COM

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