In the age of prospective payment, we are often asked, “do Medicare and Medicaid cost reports really matter anymore?” The answer is a resounding yes! Clearly, for cost-based reimbursement facilities, such as critical access hospitals, the answer is obvious. However, even for prospective payment facilities, Medicare/Medicaid cost reporting continues to be extremely important. Among other uses, the cost report is a vital component of:

  • CMS’ (Medicare) calculation of the annual marketplace basket rate increases,
  • Medicare wage index calculation,
  • State Medicaid agency’s calculation of cost and reimbursement,
  • State Medicaid agency’s allotment of DSH funding,
  • State Medicaid agency’s Section 1115 waiver calculations and related funding,
  • Payer negotiations,
  • Benchmarking, and
  • Public perception and peer/competitor analysis.

In addition, for skilled nursing facilities, Medicaid funding is often directly tied to the cost report.

In short, although prospective payment reigns supreme today, the Medicare and Medicaid cost reports have not lost their place as the “one source of truth” to government and private payers, as well as the industry at large.

CRI’s healthcare reimbursement team is acutely aware of the intricacies of preparing and filing accurate, and beneficial, cost reports, and we leverage our depth of experience and expertise to assist each of our clients across the full spectrum of cost reporting.  From preparing cost reports and DSH surveys, to various reimbursement related advisory opportunities (Schedule H, Wage Index, DSH, Medicare bad debts, etc.), CRI’s healthcare reimbursement team is the ace in your pocket.

Please contact your healthcare reimbursement team member to discuss ways we can assist in improving your cost reporting function and resulting reimbursement.

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Practice Leaders

Kelly Jones
Kelly Jones
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