1	Cost Reporting – The Basics Ron L. Nelson, PA and Chris A. Christoffersen
2	Cost Reporting Information Needed to Complete the RHC Cost Report
3	RHC Designation Provider based – owned, operated by Hospital, SNF, HHA (Schedule M) Independent – (Freestanding) – may be MD/DO owned, privately owned or owned by other health professionals (HCFA 222)
4	RHC Cost Report Method to reconcile and verify payments to allowable costs. Allowable RHC Costs/RHC Visits = RHC Cost Per Visit = RHC rate; not to exceed the maximum allowable reimbursement rate for current period. Determines future reimbursement rates. Cost reports are due five months after FYE. Medicare FI provides (PS&R) Provider Summary Report 120 days after FYE.
5	RHC Cost Report Cost reports must be submitted in electronic format (ECR File) on CMS approved software.
6	Information Needed to Complete the RHC Cost Report Financial Statements Visits (Worksheet 2) Clinic Hours of Operation FTE Calculations (Worksheet 4) Total number of nursing staff hours worked during the cost report period.
7	Information Needed to Complete the RHC Cost Report Staff of RHC (Worksheet 5) Vaccine Information (Worksheet 6 and Sample Vaccine Logs) Payments received Depreciation Schedule
8	Information Needed to Complete the RHC Cost Report Medicare Bad Debt (Worksheet 9) Laboratory Costs (Worksheet 11) Non-RHC Xray Costs (Worksheet 11a) PSR from fiscal intermediary
9	Financial Statements Balance Sheet Profit and Loss Statement Trial Balance
10	RHC Visits (Worksheet 2) Broken down by provider and by insurance type for all health care providers Count only face-to-face encounters Do not include visits for hospital, non covered services, non qualified providers or injections
11	Visit Summary - Worksheet 2
12	Clinic Hours of Operation RHC Hours Non-RHC Hours (if applicable) – must have reasonable methodology for carve out (i.e. average time spent, visits, space, clinical hours)
13	FTE Calculation (Worksheet 4) Average hours worked per week for each health care provider at the RHC: Average administrative hours worked per week (used to reclassify wages of provider) Average patient care hours worked per week (used to calculate the FTE inputted on the cost report for the provider) Average inpatient care hours worked per week (used to adjust wages of provider)
14	FTE Calculation - Worksheet 4
15	Nursing Staff Hours Total number of nursing staff hours worked per year (for use in calculating the staff time ratio of time available for giving vaccines). RN LPN MA
16	Staff of RHC Job Titles Gross Wages Fringe benefits and payroll taxes of all providers and clinical staff
17	Staff Wages - Worksheet 5
18	Vaccine Information (Worksheet 6) Influenza and Pneumovax Total vaccines given of each to all insurance types Total Medicare vaccines given of each (log must accompany cost report – sample log attached Cost per dose of each from invoices
19	Worksheet 6
20	Influenza Log
21	Pneumo Log
22	Payments Received Medicare FFS payments, lump sum adjustment payments (if applicable), Beneficiary deductible Payments are based on Date of Service not when payment was received Do not include MA plan payments
23	Depreciation Schedule Date Asset Purchased Description of Asset Cost of Asset
24	Medicare Bad Debts (Worksheet 9) Medicare bad debt form must accompany cost report of total bad debt being claimed. Medicare bad debt is claimed on the cost report based on which fiscal year the bad debt was written off in, not date of service.
25	Medicare Bad Debt - Worksheet 9
26	Lab/Xray Allocations (Worksheet 11) Staff performing lab duties Allocate % of time for non-RHC carve out for staff performing non-RHC lab/xray duties vs. RHC duties Time studies of staff to support the allocated carve out
27	Lab Allocation - Worksheet 11
28	X-ray Allocation - Worksheet 11A
29	PSR Medicare FI provides PSR 120 days after FYE – will be certified mailed to the clinic. Compare PSR total to your visit count. Is this accurate? If not, determine why and if this is a common issue that occurred when pulling all insurance visit types on Worksheet 2.
30	Summary Checklist