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 PRM 15-2, Chapter 40, § 4012, Exhibit 3B and 3C). 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.
Tips for Preparing S-10 Listings
Charity Listing
- The Charity listing should be in excel format.
- Ensure that all requested data elements are included.
- Roll up activity into one line item per patient encounter. This should be done by charity category (i.e. Insured or Uninsured).
- Ensure that no physician or professional services are included.
- Ensure all write-off dates are in the current Fiscal Year.
- If total charges for an item are $0, remove the item from the listing.
- Remove items with $0 charity care write off from the listing.
- 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.
- 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.
- Uninsured Charity Write-offs – Ensure that those items with no insurance payments are properly classified as uninsured.
- Insured Charity Write-offs – Ensure that those items with an insurance payment and a contractual allowance are properly classified as insured.
- Verify that charity care charges are properly classified:
- Uninsured
- Uninsured Charity Care (full or partial charity write-offs);
- Non-covered services provided to Medicaid eligible and indigent care program patients written off to charity care (and meet charity care/financial assistance policy);
- Charity care for patients with coverage from an entity without a contractual or inferred contractual relationship (and meet charity care/financial assistance policy).
- Patients that are insured that were determined to be uninsured for the entire hospital stay.
- Insured
- Deductibles, coinsurance, and copays under third-party coverage (public or private insurer) written off to charity care.
- Do not include deductibles and coinsurance claimed as Medicare bad debts.
- 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).
- Charges other than deductible, coinsurance, and co-payment amounts that represent the insured patient’s liability for medically necessary hospital services (subject to the CCR).
- Uninsured
Bad Debt Listing
- Ensure that all requested data elements are included.
- Roll up activity into one line item per patient encounter.
- Ensure that no physician or professional services are included.
- Ensure that all write-off dates are in the current Fiscal Year.
- Remove $0 bad debt items from the listing.
- 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
- Combine the charity and bad debt listings.
- Use or create a unique identifier for each item and check for duplicates. If duplicates are noted, remove them from one of the listings.
Updated: 02.13.2025
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