If this is a Medicare cost report, why do I need to include data on all of the non-Medicare patients in my facility?

The Medicare cost report measures total costs per unit for your facility.  Units differ based on facility type – for example, Patient Days for SNFs, Visits by Discipline for HHAs and FQHCs, and Patient Days per Levels of Care for Hospices.

Medicare wants to see how much the total costs were for each unit, regardless of who is paying for those costs.  The cost report will take total costs and divide by total number of visits or total number of patient days to arrive at the actual cost per visit/ per patient day.  This produces an accurate measurement of how much each unit actually cost your facility.

When determining per-unit cost, it makes no difference whether Medicare, Medicaid, an MCO, Social Security, or private insurance is paying for those costs.  Once the cost is determined, then the cost report may, in some instances, multiply the per-unit cost by the total number of Medicare units to show you how much your Medicare patients cost your facility.

If your facility is cost-reimbursed, not reimbursed under a prospective payment system, the final amounts will be used to determine your reimbursement.  This only applies, as of this writing, to a select few facility types.  Most facilities, at this point, are reimbursed based on a prospective payment system.

The main use of the per-unit costs determined by the cost report is that Medicare uses them in future rate-setting.  It determines the overall average cost of each unit, taking into account factors like wage index and geographical area, and uses them to set the reimbursement rates for all facilities.

Disclaimer:  This blog does not contain legal advice. What it does contain are our best
explanations, advice, and suggestions to help facilities and cost report preparers to understand the cost report forms and reporting process and offer suggestions for their preparation. Progressive Provider Services assumes no legal responsibility for the content of this blog, nor for cost reports or other reports prepared based on the content herein.