Get the training and information you need to help improve Medicare reimbursements and financial operating results at your Medicare designated Critical Access Hospital.
Critical Access Hospitals (CAHs) receive cost-based reimbursement for services rendered to Medicare beneficiaries. CAHs benefit immensely under the cost-based reimbursement system, but only if you know how to appropriately operate under this unique reimbursement system.
This Boot Camp is designed to provide CAH leaders with a fundamental understanding of the Medicare program’s cost-based reimbursement system; and strategies for obtaining all the Medicare reimbursement the CAH is entitled to under the Medicare cost reporting regulations and cost report instructions. A comprehensive understanding of cost-based reimbursement will allow hospital executives, board members, and finance staff to develop effective and comprehensive financial and operational strategies for Critical Access Hospitals.
We recommend this course for healthcare leaders of a Critical Access Hospital, or a system that owns or operates a CAH, including:
- Revenue cycle and reimbursement professionals
- Controllers or members of the accounting staff (and others involved in the cost report compilation process)
- Financial Analysts
- CEOs, COOs, Hospital Board members
- Introduction to the Medicare Critical Access Hospital program, its history, and CAH Medicare Conditions of Participation
- Basic principles of cost-based reimbursement. This session summarizes the Medicare cost apportionment formulary, overview of allowable and non-allowable costs, uniform pricing rule and Medicare utilization that drives Medicare cost-based reimbursement
- How Medicare cost-based reimbursement affects your hospital’s financial decision-making and financial results
- How Medicare cost reimbursements increase or decrease with changing volumes, costs, payor mix, and product mix
- How Medicare cost reimbursements change when service lines are added or deleted and how to utilize this knowledge to make sound product line decisions
- Overview of physician practice settings and reimbursement methodologies under the physician fee schedule reimbursement system, provider-based physician practices, and Medicare certified Rural Health Clinics and Federally Qualified Health Centers
- RHC Medicare conditions of participation requirements, covered services, and basic RHC billing
- Medicare regulatory requirements for establishing provider-based physician practices, provider-based RHCs and other provider-based type services; such as diagnostic centers, therapy centers, urgent care centers, etc
- Reimbursement benefits and pitfalls of establishing either a Medicare-certified Rural Health Clinic or a Provider-Based Clinic
- Compliance issues associated with provider-based clinics and other provider-based settings
- The relationship between cost report settlements, patient volume, and hospital Medicare contractual allowances and adjustments
- A handful of issues specific to CAHs that require whole CAH awareness such as CAH pricing pitfalls and strategies, the importance of Medical Utilization Review function in the CAH, billing issues specific to CAHs that require non-accountant understanding and other developments within the CAH and rural health care in America. Some of these sessions change as CAH payment issues evolve
- We will finish this part of the program with general highlights of the cost report compilation and filing process as well as the overall flow of the cost report for the non-accountant
- Review Medicare cost report forms and Medicare cost apportionment formulas within the forms. Major cost report worksheets will be discussed in detail, including compilation requirements and cost report worksheets specific to Medicare Rural Health Clinics. Attendees will comprehend the purpose of each worksheet within the cost report forms, data required to be compiled for each worksheet, and how the cost report “flows” to determine a hospitals Medicare program settlement amounts
- Underlying cost reporting issues that affect reimbursements and final settlement, as well as cost reporting strategies and reporting practices that yield appropriate Medicare reimbursements, will be discussed and highlighted
- Detailed cost reporting issues such as:
- Cost Report Questionnaire (now incorporated into cost report, previously a separate report CMS-339)
- Reporting requirement for patient statistics such as patient days and observation days
- Medicare allowable cost principles, Medicare cost allocation methodology, and the Medicare cost apportionment process
- How to review the Medicare Cost Report for overall accuracy including the cost report settlement estimates
- Compilation and work paper compilation practices that will result in accurate and complete Medicare cost reimbursements and cost report documentation
- Discussions on cost-based reimbursement issues such as:
- Physician compensation costs and allowable emergency department physician staffing costs
- Interest costs and other capital cost issues
- Other Medicare defined non-allowable costs
- Cost allocation strategies that yield appropriate hospital reimbursements by minimizing cost allocation to non-reimbursable cost centers and non-cost-based reimbursed services
- How hospital revenue reporting, charge structure, and Medicare revenues affect cost reimbursement and potential pricing strategies to minimize adverse Medicare reimbursement effects
- Hospital facility replacement and or major renovations: estimating the amount of capital costs Medicare will reimburse and methods to increase capital costs reimbursement levels
- Proper matching of costs revenues and Medicare program revenues
- Reviewing the Medicare cost report and key data points to always verify before filing a Medicare cost report.
- Note: Participants will receive a copy of QHR’s cost report review checklist and other relevant handouts to assist with annual cost report compilation process
Presenters for this event:
This event will feature some of the best and brightest we have to offer. Click on a presenter's name to view their bio.
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