CCRS Cost Report Specialist cheat sheet

Form CMS-2552-10 is the annual hospital cost report used to settle Medicare allowable costs; it is filed for each participating provider and certified by an authorized official.

Worksheet S-2 captures provider identification, ownership, bed counts, and facility characteristics used to determine applicable Medicare reimbursement rules.

Worksheet A begins with the trial balance and applies reclassifications and adjustments to convert unallowable or misclassified expenses into allowable Medicare cost centers.

Worksheet B allocates general-service and non-revenue-producing costs to revenue-producing centers using statistical measures; Worksheet C apportions those costs to Medicare.

The Worksheet E series computes Medicare settlement for inpatient and outpatient services, including pass-through, IME, DSH, and bad-debt adjustments.

Worksheet S-10 collects charity care, non-Medicare bad debt, Medicaid shortfall, and uncompensated-care data used in Medicare DSH pool distribution.

A hospital cost report is generally due five months after the fiscal year end; a MAC may grant an extension when a timely request is made before the due date.

Electronic filing is required through CMS-approved software or the MAC system; the PS&R report is the primary source for Medicare payment data.

An amended cost report must be clearly identified; the MAC may reopen and revise a settled report within applicable reopening limits.

Step-down allocation begins with the most general non-revenue-producing center and proceeds to patient-care centers; costs cannot be allocated back to a center already closed.

Allowable cost must be related to patient care, reasonable in amount, and not excluded by Medicare statute or regulation; unallowable costs are removed on Worksheet A-8.

Reasonable cost includes direct costs plus allocated overhead; cost must be supported by documentation and must not exceed what a prudent buyer would pay.

Cost-to-charge ratio = total allowable cost for a cost center / total charges for that cost center; Medicare's share = ratio x Medicare charges.

A step-down statistic must be measurable, auditable, and representative of the service received; examples include square footage, pounds of laundry, meals, and patient days.

Related-party transactions must be disclosed and are allowable only up to the amount that would have been paid in an arm's-length transaction.

Depreciation is allowable based on historical cost and useful life; depreciation on donated assets or assets funded by grants is generally not allowable.

Interest is allowable when the borrowing is necessary and proper, the rate is reasonable, and the proceeds are used for allowable provider purposes.

IPPS pays a prospective rate per discharge based on the MS-DRG; the rate is adjusted for wage index, IME, DSH, outliers, transfers, and other statutory factors.

OPPS pays for hospital outpatient services by APC; each APC has a relative weight and payment is wage-index adjusted, with packaging and pass-through rules.

Under IPPS, a transfer to another acute-care hospital before the geometric mean length of stay generally triggers a per-diem payment rather than the full DRG amount.

Cost outliers provide additional IPPS payment when estimated costs exceed the outlier threshold; payment uses a marginal cost factor applied to costs above the threshold.

Critical access hospitals are paid 101% of reasonable cost rather than under IPPS or OPPS, subject to CAH conditions of participation.

The IPPS wage index adjusts the labor-related share of the standardized amount; hospitals with higher wage costs receive a higher wage-index adjustment.

Sole community hospitals and Medicare-dependent hospitals may receive special IPPS payments or cost-based floors under applicable rules.

The cost report settles IPPS pass-through, IME, DSH, uncompensated-care, and bad-debt amounts; the DRG payment itself is not recalculated on the cost report.

Medicare DSH percentage = (Medicare SSI inpatient days + Medicaid inpatient days) / total inpatient days, subject to statutory day-count rules.

For IPPS hospitals, Medicare DSH payment equals 25% of the empirically justified DSH amount plus 75% of the uncompensated-care pool allocation.

The uncompensated-care portion of DSH is distributed using each hospital's share of total uncompensated care, based largely on Worksheet S-10 data.

IME adjustment uses the resident-to-bed ratio; the statutory formula applies an exponent of 0.405 to (1 + resident-to-bed ratio).

The resident-to-bed ratio counts full-time-equivalent residents divided by available inpatient beds, with special rules for new programs and excluded units.

Medicaid shortfall and charity care are reported on Worksheet S-10; non-Medicare bad debt may be included in uncompensated care, but Medicare bad debt is not.

DSH and IME are available only to IPPS hospitals; CAHs and other cost-based providers are excluded from these IPPS adjustments.

The 75% DSH pool is funded at a statutory amount and allocated proportionally; hospitals with higher uncompensated-care costs receive larger shares.

Medicare bad debt is a deductible or coinsurance amount uncollectible from a Medicare beneficiary after reasonable collection efforts; it must relate to covered services.

Allowable Medicare bad debts are reimbursed at 65% of the amount, subject to documentation and collection-effort requirements.

Bad debt is distinct from charity care: charity care is waived based on financial assistance eligibility, while bad debt is uncollectible after billing and collection attempts.

Provider-based status requires common ownership and control, integrated clinical services, a unified medical record, and compliance with the 35-mile location rule with exceptions.

Provider-based departments bill under the hospital's outpatient PPS; the facility fee and professional fee are separate, and the department must be integrated with the main provider.

Charity care and Medicaid shortfall are reported on Worksheet S-10 but are not directly reimbursed as Medicare allowable costs.

Medicare bad debt must be claimed on the cost report with supporting collection records, and accounts must be written off the provider's books.

The MAC reviews the cost report and issues a Notice of Program Reimbursement that states the final settled amounts and any adjustments.

A provider may appeal a final reimbursement determination to the Provider Reimbursement Review Board within 180 days after the NPR, subject to amount-in-controversy rules.

The MAC may reopen a cost report within three years after the NPR, or later for fraud, material misrepresentation, or other specified exceptions.

Unsupported costs, related-party excess costs, and non-patient-care expenses are common audit disallowances; documentation must support statistics and allocations.

The cost report certification is a compliance statement; false or unsupported claims can trigger False Claims Act, Civil Monetary Penalty, and program-integrity exposure.

Reconciling PS&R payment data to cost report receivables and statistics is a key control for accurate Medicare settlement.

Cost report records should be retained for at least five years after the report is filed or settlement is final.

A change in cost allocation, wage index, DSH/IME, or bad-debt treatment can materially affect reimbursement and may require amended reporting.