Cost Report Questions to Consider

Healthcare is a highly regulated and constantly changing industry.  The reimbursement from Medicare and Medicaid requires a deep understanding of the current issues and possible future trends. Small changes in cost report and other compliance filings can have major impacts on current and future payments to your facility.  The Medicare and Medicaid cost reports can be confusing.  Minor changes that seem to have no direct financial impact can have substantial downstream effects. Many items related to departmental allocations can impact the placement of revenues or expenses, driving changes in the cost-to-charge ratios and yielding impacts in reimbursement.

Have you considered these questions recently:

• Have your trial balance revenues and expenses been assigned to the correct cost centers to ensure the proper matching of revenues and expenses and RCC accuracy?
• Have administrative costs (Part A) for physicians and mid-levels been appropriately identified and supported through time studies or other means?
• Is ER standby time being accounted for as an administrative Part A cost?
• Are you fully capturing all of your Medicare and dual-eligible bad debts, and are they being written off with the proper coding?
• Are your patient financial policies written, up to date, and being properly followed?
• Are you identifying and categorizing all of your uncompensated care accounts correctly according to the current rules for Worksheet S-10?
• Are there any Wage Index related opportunities for your facility?  Potentially, geographic reclassifications or capturing of additional unreported contract labor that can have a significant impact of the labor portion of every Medicare claim paid.
• Are you currently receiving 340b drug discounts?
• Are your Medicare Worksheet B statistics up to date and accurately identifying the distribution of costs to the various departments in your facility?

These are just a sample of questions that the cost report preparer needs to think about as they work through the preparation process.

For more infomation, please contact:

Richard T. (Terry) Lang, CPA, FHFMA- tlang(at)microscopehc.com / 716-440-6189