CCRS Cost Report Specialist flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

CMS-2552-10

The annual Medicare hospital cost report form used to report allowable costs, statistics, and settlement data for participating providers.

Worksheet S-2

Cost report worksheet that captures provider identification, ownership, bed count, and facility characteristics used to determine applicable Medicare payment rules.

Worksheet A

Cost report worksheet that begins with the trial balance and applies reclassifications and adjustments to arrive at allowable Medicare cost centers.

Worksheet B

Cost report worksheet that allocates general-service and non-revenue-producing cost center costs to revenue-producing departments using statistical measures.

Worksheet C

Cost report worksheet that apportions revenue-producing department costs to Medicare using departmental cost-to-charge ratios or other approved methods.

Cost report due date

A hospital cost report is generally due five months after its fiscal year end; the MAC may extend the deadline if a timely request is made.

Step-down allocation

A cost-finding method that allocates non-revenue-producing costs to other cost centers in sequence, from general to patient-care centers, without allocating back.

Allowable cost

A cost that is related to patient care, reasonable in amount, properly documented, and not excluded by Medicare statute or regulation.

Cost-to-charge ratio

Total allowable cost for a cost center divided by total charges for that center; it converts Medicare charges into Medicare allowable cost.

Reasonableness

A Medicare standard requiring that costs be necessary and comparable to what a prudent buyer would pay in an arm's-length transaction for similar services.

Related-party cost

A cost arising from a transaction with an affiliated organization; it must be disclosed and is allowable only up to an arm's-length amount.

Depreciation

A cost allocation for the decline in value of allowable assets over useful life, generally based on historical cost and excluding donated or grant-funded assets.

IPPS MS-DRG payment

A prospective per-discharge payment for inpatient hospital services, based on the assigned MS-DRG and adjusted for wage index, IME, DSH, and outliers.

OPPS APC payment

A prospective payment for hospital outpatient services based on the Ambulatory Payment Classification group, relative weight, wage index, and packaging rules.

Transfer payment rule

When an IPPS patient is transferred before the geometric mean length of stay, Medicare generally pays a per-diem amount instead of the full DRG payment.

Cost outlier

An additional IPPS or OPPS payment when estimated costs exceed a threshold; IPPS uses a marginal cost factor for costs above the threshold.

Critical access hospital

A small rural hospital meeting CAH conditions; Medicare pays 101% of reasonable cost rather than IPPS or OPPS rates.

DSH percentage

The ratio of Medicare SSI inpatient days plus Medicaid inpatient days to total inpatient days, used to calculate the empirically justified DSH amount.

Medicare DSH payment

For IPPS hospitals, 25% of the empirically justified DSH amount plus 75% of the hospital's share of the uncompensated-care pool.

IME adjustment

An IPPS payment adjustment for indirect medical education costs, using the resident-to-bed ratio and a statutory exponent of 0.405.

Resident-to-bed ratio

Full-time-equivalent residents divided by available inpatient beds; it drives the indirect medical education adjustment for IPPS hospitals.

Uncompensated care

Charity care and non-Medicare bad debt reported on Worksheet S-10; it is used to distribute the 75% Medicare DSH uncompensated-care pool.

Worksheet S-10

The cost report worksheet that collects charity care, non-Medicare bad debt, Medicaid shortfall, and uncompensated-care data for DSH pool allocation.

Medicare bad debt

A Medicare deductible or coinsurance amount that remains uncollectible after reasonable collection efforts and relates to covered services.

Bad debt reimbursement

Medicare reimburses 65% of allowable Medicare bad debts, subject to collection-effort documentation and cost report claiming requirements.

Charity care

Free or discounted patient care provided under a financial assistance policy; it is distinct from bad debt and reported on Worksheet S-10.

Provider-based status

A Medicare designation requiring common ownership, integrated clinical services, a unified medical record, and compliance with location and certification rules.

Provider-based billing

A hospital department billing under the hospital's outpatient prospective payment system, with separate facility and professional components where applicable.

Notice of Program Reimbursement

The MAC's final written settlement of a provider's cost report, stating allowable reimbursement and adjustments; it starts appeal and reopening timelines.

PRRB appeal

A provider appeal to the Provider Reimbursement Review Board, generally filed within 180 days after the NPR and subject to amount-in-controversy rules.

Cost report reopening

A MAC revision of a settled cost report, generally allowed within three years after the NPR except for fraud or other specified exceptions.

Cost report certification

The signed statement by an authorized provider official that the cost report and supporting records are true, complete, and prepared under applicable Medicare rules.