CCRS Cost Report Specialist study guide
CCRS Cost Report Specialist · Work through your exam, one topic at a time.
The Certified Hospital Cost Report Specialist (CHCRS) is a healthcare finance credential listed on HFMA's certifications index. HFMA's own description is brief: the program is shown at 10 CPEs, and its content is described as "an in-depth presentation of key components of hospital cost reporting." The credential is aimed at people who build, review, or audit hospital cost reports - reimbursement analysts, cost accountants, reimbursement managers, consultants, and auditors who must defend a filed report under scrutiny. The CCRS Cost Report Specialist study guide has 6 sections and about 1,817 words.
01Cost Report Structure, Worksheets, and Filing Mechanics
The hospital Medicare cost report is filed on CMS-2552-10 and is structurally a linked model rather than a stack of independent forms. Worksheet S-2 captures provider demographics, the cost reporting period, and settlement data; an inconsistency between S-2 and the detail schedules is a classic finding.
308 words, about 2 min02Cost Finding, Step-Down Allocation, and Allowable Cost Determination
Cost finding starts with the principle that Medicare pays reasonable cost: costs that are ordinary, necessary, and related to patient care, as defined in 42 CFR 413.9. Nonallowable items, including advertising, donations, most research, separately billed physician professional services, patient conveniences, and costs of non-reimbursable cost centers, are removed or isolated before allocation.
309 words, about 2 min03Inpatient and Outpatient Prospective Payment Settlement
Under IPPS, the operating and capital base rates are set prospectively: payment equals the MS-DRG weight times the wage-adjusted base rate, plus adjustments for IME, DSH, outliers, transfers, and pass-through items. The cost report therefore does not cost out a routine Medicare inpatient stay.
286 words, about 1 min04Disproportionate Share, IME, and Uncompensated Care Payment Calculations
Medicare DSH has two pieces. The empirically justified portion is 25% of the DSH pool and is computed from the hospital's DSH adjustment percentage, which blends the SSI fraction, drawn from SSA data rather than the cost report, and the Medicaid fraction, meaning Medicaid inpatient days divided by total inpatient days.
278 words, about 1 min05Bad Debts, Charity Care, and Provider-Based and Departmental Reporting
Medicare bad debt is the uncollectible deductible and coinsurance portion of covered services furnished to Medicare beneficiaries. To be allowable, the debt must be the provider's own, must follow a reasonable and documented collection effort, must be written off, and must be reduced by any recovery.
325 words, about 2 min06Cost Report Review, Audit, Reimbursement Impact, and Compliance
The cost report is a certified claim, and the MAC reviews it through desk review and, where risk warrants, audit. Desk review compares the report to prior years, to S-2 and S-10 detail, and to cost-to-charge ratio outliers; audit may sample claims and trace them to the report.
311 words, about 2 min