Each year, Medicare-certified providers must submit a report containing charges, facility characteristics, financial information and data to a Medicare Administrative Contractor. Medicare cost reporting software is a vital tool for preparing this file.

Preparing the Report

To have a complete and accurate cost statement, medical providers need to:

  • Create a detailed plan with a timeline for completion.
  • Understand the necessary regulations and requirements.
  • Check the provider reimbursement manual.
  • Follow the instructions and formats.
  • Have all the required information.

Understanding the Importance 

It is essential to understand what must be in the report. The sheer volume of data is challenging.

  • Health care institutions must complete two report sets, each containing many forms.
  • Each permanent code number needs to match the hospital’s filing code number.
  • The data directly affects the financial future of a facility.
  • The information must be accurate to optimize a pricing strategy that meets the institution’s goals and is in line with regulations.
  • When providers misfile reports, it can have costly repercussions. In a worst-case scenario, Medicare stops reimbursing the medical institution.
  • There are no filing extensions.
  • Overdue submissions result in penalties and suspended payments.

Gathering Information

Detailed information each step of the way is vital to ensure cost reporting goes well. A facility must provide evidence supporting the decisions regarding patient care. Providers must store data securely, even after submitting because it may take years for Medicare to audit. In an audit, a robust data and analytics foundation is essential to provide the needed information. Analytics also identify and correct workflows, ensuring proper forms from the beginning.

Ensuring Accuracy

This data goes into the Healthcare Provider Cost Reporting Information System. It helps analyze profitability, set future rates, determine reimbursement rates and make policy decisions. Health care providers have access to a checklist provided by the HCRIS. Facilities must amend forms with missing or incorrect data. The requirements are stringent, and the government may not approve requests to reopen, costing the facility money due to mistakes.

Researching Data

The Centers for Medicare and Medicaid Services approximates the questions require an average of 200 hours of research.

  • Facility characteristics include the number of beds, ownership (government, for-profit or nonprofit), total patient days and discharges.
  • Financial health forms detail the revenue, net income or loss, expenses, bad debt and payer mix.
  • Cost information varies by facility.

Ensuring accurate cost reporting and performing comprehensive pricing reviews benefit the facility’s bottom line and increase patient satisfaction.