REPORT ON THE COST REPORT REVIEW JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS CONCORD, CALIFORNIA PROVIDER NUMBER: ZZR00496G AND NPI NUMBER: 1801821376 FISCAL PERIOD ENDED DECEMBER 31, 2007 Audits Section - Richmond Financial Audits Branch Audits and Investigations Department of Health Care Services Section Chief: Louise Wong Audit Supervisor: David Mui Auditors: Mandy Lin and Tyler Zeng
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REPORT ON THE
COST REPORT REVIEW
JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS CONCORD, CALIFORNIA
PROVIDER NUMBER: ZZR00496G AND NPI NUMBER: 1801821376
FISCAL PERIOD ENDED
DECEMBER 31, 2007
Audits Section - Richmond Financial Audits Branch
Audits and Investigations Department of Health Care Services
Section Chief: Louise Wong Audit Supervisor: David Mui Auditors: Mandy Lin and Tyler Zeng
State of California—Health and Human Services Agency
Department of Health Care Services
TOBY DOUGLAS EDMUND G. BROWN JR. DIRECTOR GOVERNOR
January 28, 2011 George Fan Reimbursement Director John Muir / Mt. Diablo Health System 1400 Treat Boulevard Walnut Creek, CA 94597-2142 PROVIDER: JOHN MUIR MEDICAL CENTER – CONCORD CAMPUS PROVIDER NO. ZZR00496G AND NPI NO. 1801821376 FISCAL PERIOD ENDED DECEMBER 31, 2007 We have examined the provider's Medi-Cal Cost Report for the above-referenced fiscal period. Our examination was made under the authority of Section 14170 of the Welfare and Institutions Code and, accordingly, included such tests of the accounting records and such other auditing procedures as we considered necessary in the circumstances. In our opinion, the audited settlement for the fiscal period due the provider in the amount of $3,889,824 presented in the Summary of Findings represent a proper determination in accordance with the reimbursement principles of the applicable program. This audit report includes the: 1. Summary of Findings 2. Computation of Audited Medi-Cal Reimbursement Settlement (NONCONTRACT
Schedules) 3. Audit Adjustments Schedule The audited settlement will be incorporated into a Statement of Account Status, which may reflect tentative retroactive adjustment determinations, payments from the provider, and other financial transactions initiated by the Department. The Statement of Account Status will be forwarded to the provider by the State's fiscal intermediary. Instructions regarding payment will be included with the Statement of Account Status.
850 Marina Bay Parkway, Building P, 2nd Floor, MS 2104, Richmond, CA 94804-6403 Telephone: (510) 620-3100 FAX: (510) 620-3111
Internet Address: www.dhcs.ca.gov
George Fan Page 2
Notwithstanding this audit report, overpayments to the provider are subject to recovery pursuant to Section 51458.1, Article 6 of Division 3, Title 22, California Code of Regulations. If you disagree with the decision of the Department, you may appeal by writing to: John Melton, Chief Office of Administrative Appeals and Hearings 1029 J Street, Suite 200 MS 0017 Sacramento, CA 95814 (916) 322-5603 The written notice of disagreement must be received by the Department within 60 calendar days from the day you receive this letter. A copy of this notice should be sent to: United States Postal Service (USPS) Courier (UPS, FedEx, etc.) Assistant Chief Counsel Assistant Chief Counsel Department of Health Care Services Department of Health Care Services Office of Legal Services Office of Legal Services MS 0010 MS 0010 P.O. Box 997413 1501 Capitol Avenue, Suite 71.5001 Sacramento, CA 95899-7413 Sacramento, CA 95814-5005 (916) 440-7700 The procedures that govern an appeal are contained in Welfare and Institutions Code, Section 14171, and California Code of Regulations, Title 22, Section 51016, et seq. If you have questions regarding this report, you may call the Audits Section—Richmond at (510) 620-3100. Original Signed by Louise Wong, Chief Audits Section—Richmond Financial Audits Branch Certified
Provider Name: Fiscal Period Ended:JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS DECEMBER 31, 2007
10. Patient and Third Party Liability (Adj ) $ 0 $ 0
11. Net Cost of Covered Services Rendered to Medi-Cal Inpatients $ 11,963,293 $ 13,303,359
(To Schedule 1)
COMPUTATION OFMEDI-CAL NET COSTS OF COVERED SERVICES
STATE OF CALIFORNIA SCHEDULE 4PROGRAM: NONCONTRACT
Provider Name: Fiscal Period Ended:JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS DECEMBER 31, 2007
Provider No.ZZR00496G
GENERAL SERVICE UNIT NET OF SWING-BED COSTS REPORTED AUDITED
INPATIENT DAYS 1. Total Inpatient Days (include private & swing-bed) (Adj ) 43,554 43,554 2. Inpatient Days (include private, exclude swing-bed) 43,554 43,554 3. Private Room Days (exclude swing-bed private room) (Adj ) 0 0 4. Semi-Private Room Days (exclude swing-bed) (Adj ) 43,554 43,554 5. Medicare NF Swing-Bed Days through Dec 31 (Adj ) 0 0 6. Medicare NF Swing-Bed Days after Dec 31 (Adj ) 0 0 7. Medi-Cal NF Swing-Bed Days through July 31 (Adj ) 0 0 8. Medi-Cal NF Swing-Bed Days after July 31 (Adj ) 0 0 9. Medi-Cal Days (excluding swing-bed) (Adj 21) 2,679 2,877 SWING-BED ADJUSTMENT17. Medicare NF Swing-Bed Rates through Dec 31 (Adj ) $ 0.00 $ 0.0018. Medicare NF Swing-Bed Rates after Dec 31(Adj ) $ 0.00 $ 0.0019. Medi-Cal NF Swing-Bed Rates through July 31(Adj ) $ 0.00 $ 0.0020. Medi-Cal NF Swing-Bed Rates after July 31(Adj ) $ 0.00 $ 0.0021. Total Routine Serv Cost (Sch 8, Line 25, Col 27) $ 65,033,973 $ 62,505,89222. Medicare NF Swing-Bed Cost through Dec 31 (L 5 x L 17) $ 0 $ 023. Medicare NF Swing-Bed Cost after Dec 31 (L 6 x L 18) $ 0 $ 024. Medi-Cal NF Swing-Bed Cost through July 31 (L 7 x L 19) $ 0 $ 025. Medi-Cal NF Swing-Bed Cost after July 31 (L 8 x L 20) $ 0 $ 026. Total Swing-Bed Cost (Sum of Lines 22 to 25) $ 0 $ 027. Inpatient Routine Cost Net of Swing-Bed (L 21 minus L 26) $ 65,033,973 $ 62,505,892
PRIVATE ROOM DIFFERENTIAL ADJUSTMENT28. Gen Inpatient Routine Serv Charges (excl swing-bed charges) $ 285,454,959 $ 285,454,95929. Private Room Charges (excluding swing-bed charges) $ 0 $ 030. Semi-Private Room Charges (excluding swing-bed charges) $ 285,454,959 $ 285,454,95931. Gen Inpatient Routine Service Cost/Charge Ratio (L 27 / L 28) $ 0.227826 $ 0.21896932. Average Private Room Per Diem Charge (L 29 / L 3) $ 0.00 $ 0.0033. Average Semi-Private Room Per Diem Charge (L 30 / L 4) $ 6,554.05 $ 6,554.0534. Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33) $ 0.00 $ 0.0035. Average Per Diem Private Room Cost Differential (L 31 x L 34) $ 0.00 $ 0.0036. Private Room Cost Differential Adjustment (L 35 x L 3) $ 0 $ 037. Inpatient Rout Cost Net of Swing-Bed & Prvt Rm (L 27 minus L 36) $ 65,033,973 $ 62,505,892
PROGRAM INPATIENT OPERATING COST 38. Adjusted General Inpatient Routine Cost Per Diem (L 37 / L 2) $ 1,493.18 $ 1,435.1439. Program General Inpatient Routine Service Cost (L 9 x L 38) $ 4,000,229 $ 4,128,898
42. TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 39,40 & 41) $ 6,174,455 $ 6,649,038( To Schedule 3 )
COMPUTATION OFMEDI-CAL INPATIENT ROUTINE SERVICE COST
STATE OF CALIFORNIA SCHEDULE 4APROGRAM: NONCONTRACT
Provider Name: Fiscal Period Ended:JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS DECEMBER 31, 2007
Provider No.ZZR00496G
SPECIAL CARE AND/OR NURSERY UNITS REPORTED AUDITEDNURSERY 1. Total Inpatient Routine Cost (Sch 8, Line 33, Col 27) $ 0 $ 0 2. Total Inpatient Days (Adj ) 0 0 3. Average Per Diem Cost $ 0.00 $ 0.00 4. Medi-Cal Inpatient Days (Adj ) 0 0 5. Cost Applicable to Medi-Cal $ 0 $ 0
INTENSIVE CARE UNIT 6. Total Inpatient Routine Cost (Sch 8, Line 26, Col 27) $ 21,514,012 $ 19,911,508 7. Total Inpatient Days (Adj ) 7,352 7,352 8. Average Per Diem Cost $ 2,926.28 $ 2,708.31 9. Medi-Cal Inpatient Days (Adj 21) 743 90510. Cost Applicable to Medi-Cal $ 2,174,226 $ 2,451,021 CORONARY CARE UNIT11. Total Inpatient Routine Cost (Sch 8, Line 27, Col 27) $ 0 $ 012. Total Inpatient Days (Adj ) 0 013. Average Per Diem Cost $ 0.00 $ 0.0014. Medi-Cal Inpatient Days (Adj ) 0 015. Cost Applicable to Medi-Cal $ 0 $ 0
NEONATAL INTENSIVE CARE UNIT16. Total Inpatient Routine Cost (Sch 8, Line 28, Col 27) $ 0 $ 017. Total Inpatient Days (Adj ) 0 018. Average Per Diem Cost $ 0.00 $ 0.0019. Medi-Cal Inpatient Days (Adj ) 0 020. Cost Applicable to Medi-Cal $ 0 $ 0 SURGICAL INTENSIVE CARE UNIT21. Total Inpatient Routine Cost (Sch 8, Line 29, Col 27) $ 0 $ 022. Total Inpatient Days (Adj ) 0 023. Average Per Diem Cost $ 0.00 $ 0.0024. Medi-Cal Inpatient Days (Adj ) 0 025. Cost Applicable to Medi-Cal $ 0 $ 0 ADMINISTRATIVE DAYS26. Per Diem Rate (Adj 22) $ 0.00 $ 310.6827. Medi-Cal Inpatient Days (Adj 22) 0 18728. Cost Applicable to Medi-Cal $ 0 $ 58,097
ADMINISTRATIVE DAYS29. Per Diem Rate (Adj 22) $ 0.00 $ 318.1930. Medi-Cal Inpatient Days (Adj 22) 0 3031. Cost Applicable to Medi-Cal $ 0 $ 9,546
MEDI-CAL INPATIENT ROUTINE SERVICE COSTCOMPUTATION OF
STATE OF CALIFORNIA SCHEDULE 4BPROGRAM: NONCONTRACT
Provider Name: Fiscal Period Ended:JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS DECEMBER 31, 2007 Provider No.ZZR00496G
SPECIAL CARE UNITS REPORTED AUDITED 1. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 2. Total Inpatient Days (Adj ) 0 0 3. Average Per Diem Cost $ 0.00 $ 0.00 4. Medi-Cal Inpatient Days (Adj ) 0 0 5. Cost Applicable to Medi-Cal $ 0 $ 0
6. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 7. Total Inpatient Days (Adj ) 0 0 8. Average Per Diem Cost $ 0.00 $ 0.00 9. Medi-Cal Inpatient Days (Adj ) 0 010. Cost Applicable to Medi-Cal $ 0 $ 0
11. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 012. Total Inpatient Days (Adj ) 0 013. Average Per Diem Cost $ 0.00 $ 0.0014. Medi-Cal Inpatient Days (Adj ) 0 015. Cost Applicable to Medi-Cal $ 0 $ 0
16. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 017. Total Inpatient Days (Adj ) 0 018. Average Per Diem Cost $ 0.00 $ 0.0019. Medi-Cal Inpatient Days (Adj ) 0 020. Cost Applicable to Medi-Cal $ 0 $ 0
ADMINISTRATIVE DAYS (BILLED LATE - REDUCED RATE @75%)21.22.23. Per Diem Rate (Adj 22) $ 0.00 $ 233.0124. Medi-Cal Inpatient Days (Adj 22) 0 525. Cost Applicable to Medi-Cal $ 0 $ 1,165
ADMINISTRATIVE DAYS (BILLED LATE - REDUCED RATE @50%)26.27.28. Per Diem Rate (Adj 22) $ 0.00 $ 155.3429. Medi-Cal Inpatient Days (Adj 22) 0 230. Cost Applicable to Medi-Cal $ 0 $ 311
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105
STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS DECEMBER 31, 2007
GENERAL SERVICE COST CENTERS1.00 Old Cap Rel Costs - Building and Fixtures $ 4,346,978 $ (2,957,515) $ 1,389,4632.00 Old Cap Rel Costs - Movable Equipment 1,087,902 0 1,087,9023.00 New Cap Rel Costs - Building and Fixtures 4,995,221 493,009 5,488,2304.00 New Cap Rel Costs - Movable Equipment 6,030,402 0 6,030,4024.01 0 04.02 0 04.03 0 04.04 0 04.05 0 04.06 0 04.07 0 04.08 0 05.00 Employee Benefits 42,970,869 (192,231) 42,778,6386.01 PBX 832,821 (17,935) 814,8866.02 Information System 8,706,715 (169,795) 8,536,9206.03 Purchasing/Receiving 732,518 0 732,5186.04 Patient Admitting 2,352,100 (45,870) 2,306,2306.05 Cashering 2,461,532 (48,004) 2,413,5286.06 0 06.07 0 06.08 0 06.06 Administrative and General 21,248,773 (233,208) 21,015,5657.00 Maintenance and Repairs 433,342 0 433,3428.00 Operation of Plant 6,406,282 0 6,406,2829.00 Laundry and Linen Service 459,917 0 459,917
10.00 Housekeeping 2,987,049 0 2,987,04911.00 Dietary 1,456,514 (199,904) 1,256,61012.00 Cafeteria 1,484,841 199,904 1,684,74513.00 Maintenance of Personnel 0 014.00 Nursing Administration 1,830,577 0 1,830,57715.00 Central Services and Supply 11,557,176 (9,415,021) 2,142,15516.00 Pharmacy 13,303,147 (7,778,830) 5,524,31717.00 Medical Records and Library 2,748,771 (53,605) 2,695,16618.00 Social Service 0 019.00 0 019.02 0 019.03 0 020.00 0 021.00 Nursing School 0 022.00 Intern and Res Service - Salary and Fringes 0 023.00 Intern and Res - Other Program 0 024.00 Paramedical Ed Program 98,908 0 98,908
INPATIENT ROUTINE COST CENTERS25.00 Adults and Pediatrics (Gen Routine) 32,240,584 45,086 32,285,67026.00 Intensive Care Unit 11,270,975 0 11,270,97527.00 Coronary Care Unit 0 028.00 Neonatal Intensive Care Unit 0 029.00 Surgical Intensive Care 0 030.00 Subprovider I 0 031.00 Subprovider II 0 032.00 0 033.00 Nursery 0 034.00 Medicare Certified Nursing Facility 0 035.00 Distinct Part Nursing Facility 0 036.00 Adult Subacute Care Unit 0 036.01 Subacute Care Unit II 0 036.02 Transitional Care Unit 0 0
REPORTED ADJUSTMENTS
TRIAL BALANCE OF EXPENSES
(From Sch 10A)AUDITED
STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS DECEMBER 31, 2007