CCRS Cost Report Specialist key terms

The cost report schedule that restates the provider's trial-balance expenses into standardized Medicare cost centers and applies reclassifications and adjustments before any costs are allocated to other departments.

The schedule that allocates general service costs from Worksheet A across all beneficiary-serving cost centers, using step-down or simultaneous methods and statistical bases such as square footage or accumulated cost.

The apportionment schedule that splits each cost center's allocated costs between Medicare and non-Medicare beneficiaries using the ratio of Medicare charges or utilization to total charges or utilization.

The worksheet where inpatient and outpatient prospective payment settlement is computed, comparing Medicare payments received with reimbursable amounts and deriving the net settlement due to or owed by the provider.

A required attestation schedule capturing provider identifying data, ownership, fiscal period, facility characteristics, and certification information that determines which reimbursement rules and worksheets apply to the filing.

The Provider Statistical and Reimbursement report, a CMS-generated summary of Medicare claims and payments that the contractor uses to populate utilization and settlement worksheets in the cost report.

The written contractor determination that finalizes a cost report period, stating audited reimbursable costs, settlement amounts, and appeal rights after the desk review or audit is complete.

The standard Medicare hospital and hospital health care complex cost report form, filed annually by institutional providers to report costs, charges, statistics, and settlement computations to the Medicare contractor.

A corrected filing submitted after the original cost report to fix errors or reflect new information, subject to contractor acceptance and time limits tied to the notice of program reimbursement.

An interim payment determination the contractor issues before a full audit, based on the as-filed report, which later becomes final after review and may change materially.

A cost-finding method that allocates general service costs to beneficiary-serving departments in sequence, so each department's accumulated cost, including prior allocations, is passed forward and never allocated backward.

A standardized reporting unit in the cost report that groups similar expenses and revenues, such as routine nursing or pharmacy, so costs can be allocated and apportioned consistently.

The relationship between a cost center's total allowable cost and its total charges, used to convert charges into estimated costs for apportionment, outlier payments, and other reimbursement calculations.

An adjustment that moves an expense from the cost center where it was booked to the proper Medicare cost center, supported by documentation and often changing the outcome of cost allocation.

Expenses that Medicare recognizes as reimbursable because they are reasonable, related to patient care, properly documented, and not excluded by statute, regulation, or the provider's own agreements.

A purchase of services, facilities, or supplies from an entity with common ownership or control, which Medicare reimburses only up to the cost to the related party rather than the price paid.

A statistical basis that assigns a general service department's costs across the building in proportion to floor space occupied, commonly used for housekeeping, maintenance, and operation of plant.

The systematic recognition of the cost of depreciable assets over their useful lives; Medicare reimburses allowable depreciation using approved methods, with limits on donated assets and gains on sale.

The cost of borrowing for capital assets or working capital that Medicare may reimburse when the loan is necessary, prudent, and the funds are used for patient-care purposes.

Medicare Severity Diagnosis Related Group, the inpatient classification system that assigns each discharge to a payment group based on principal diagnosis, procedures, complications, and severity.

A geographic factor reflecting local labor market wages that adjusts the labor-related portion of prospective payments, computed from hospital wage and hour data reported in the cost report.

An additional prospective payment for cases whose estimated cost exceeds a fixed threshold above the DRG payment, calculated using the hospital's cost-to-charge ratio and a marginal cost factor.

The average relative weight of a hospital's discharges, summarizing how resource-intensive its patient mix is compared with the national average and influencing expected payment levels.

Ambulatory Payment Classification, the outpatient prospective payment group that bundles clinically similar services into a single payment rate for hospital outpatient departments.

A reduction applied when a patient is discharged to a post-acute care setting, paying the hospital a per-diem share of the DRG rate because the full course of treatment was not provided.

A small rural hospital with limited beds and a short average length of stay that Medicare pays on a cost basis, generally 101 percent of reasonable costs, instead of prospective rates.

An add-on to inpatient prospective payments that recognizes the higher patient care costs of teaching hospitals, calculated from the ratio of residents to beds and a statutory multiplier.

An increase to inpatient payments for hospitals serving a disproportionate share of low-income patients, computed from Medicare SSI and Medicaid utilization percentages and the hospital's bed size.

The proportion of a hospital's Medicare beneficiaries who are also Supplemental Security Income recipients, one of two utilization measures that drive the disproportionate share adjustment percentage.

The share of a hospital's patient days attributable to Medicaid-eligible patients, including certain dual eligibles, used with the SSI ratio to compute the DSH adjustment.

The schedule reporting uncompensated care and charity care charges and costs, which CMS uses to distribute the inpatient uncompensated care pool among eligible hospitals.

An additional inpatient payment from a national pool, funded by reductions in other Medicare payments, distributed to hospitals based on their share of insured and uninsured patient costs.

Payment for the direct costs of training residents, including stipends, faculty supervision, and overhead, calculated per resident using a hospital-specific base period amount updated over time.

Unpaid patient coinsurance and deductible amounts remaining after reasonable collection efforts, for which Medicare reimburses a percentage as an adjustment on the cost report.

Free or discounted services provided to patients who are determined unable to pay under the hospital's financial assistance policy, reported separately from bad debt on the cost report.

Documented actions a provider must take to pursue payment before writing off a deductible or coinsurance balance, such as statements, notices, and referral to a collection agency.

A determination that a facility or department operates as part of the main provider, meeting integration, supervision, and billing requirements so its costs and charges appear on the main cost report.

An independent panel that hears appeals from providers dissatisfied with a contractor's final reimbursement determination when the amount in controversy meets the jurisdictional threshold.

A contractor's correction of a final settled cost report, initiated by the contractor or requested by the provider, without a formal appeal and subject to regulatory time limits.

A statistical technique that projects error rates found in a sample of claims or cost reports across the full population to determine an overpayment amount during an audit.