The FQHC Medicare cost report has been revamped. The new form for its filing is CMS Form 224-14.  This requires a lot of new data collection, since the new cost report form (i.e., software) is significantly different from the old form.

We prepared a handy checklist for FQHC cost report preparation, designed to streamline the process for you.  For instructions on how to complete the checklist, once you have it, and the cost report, read on!

FYI, the reason the FQHC cost report has been completely overhauled is to accommodate the switch-over to PPS reimbursement (see our blog:  FQHC’s are Going PPS).  There are a few exceptions which are still cost reimbursed, which are explained in the appropriate section below.

Your new FQHC software includes new worksheets to capture the following information:

• Personnel FTEs – Staff and Contract for All Healthcare Staff.  Typically, an “FTE” is someone who worked 2,080 hours in a full year.  To calculate how many FTEs you have, divide the number of hours each employee type worked by 2,080 (or by the number of hours in your cost report period, if it is less than a full year.)
• Personnel Contract and Employee Benefits – Broken Out by Healthcare Staff.  Use internal records to arrive at contract costs.  For employee benefits, if not already identified, you may calculate total facility-wide employee taxes and benefits and divide by percentages of salaries to arrive at Benefits Costs per category.
• Medical and Mental Health Visits – Broken Out by Title V (state entitlement program described in the Social Security Program, available in certain states), Title XVIII (Medicare), Title XIX (Medicaid), and Other.  Use internal records to determine these as well.
• Many Different Cost Centers  – on Worksheet A.  May require a change in how you have allocated Trial Balance expenses in the past, so pay attention!

This new report reflects the change to PPS reimbursement, with the following exceptions:

• Reimbursable Pass-Through Costs – on Worksheet A.  These are the only costs that are still cost-reimbursed, and they include GME (program for doctors in training) and vaccine costs, so make sure to accurately separate out these costs from other Trial Balance expenses in order to maximize your reimbursement.  If these costs are included in combined TB accounts, you can reclass them via Worksheet A-1.  However, GME situations at FQHCs are infrequent.

A few more changes:

• PS&R Info – On Worksheets E and E-1.  You will now need to enter information from your PS&R report regarding reimbursement amounts, co-insurance, primary payer amounts, and other PS&R info on this worksheet.  Medicare Bad Debt amounts will be entered on Worksheet E, as well.
• One More Change – No 339.  Another big change is the elimination of CMS form 339.  The FQHC relevant questions which you used to answer on this form are now included on Worksheet S-2.

Make sure to begin your cost report preparation this year with extra time to accommodate the learning curve and for gathering extra information!