What’s in a cost report?
The hospice cost report is a set of complex documents that is similar to cost reports filed by home health agencies and nursing homes. The data collected in those cost reports will be used by the Health Care Financing Administration (HCFA) to determine future reimbursement for hospices. The hospice cost report consists of three main elements:
1. Working trial balance. List of chart of accounts and the balance of each account at year’s end.
2. Form 339. A provider questionnaire that asks organizational questions.
3. Support for adjustments and reclassifications to the cost report.
Within those three cost report components there is a series of worksheets that will show Medicare carriers how a hospice determined the data it submitted. The report provides the following worksheets and attachments:
• WORKSHEET S-1. Hospices will provide data on days of care by reimbursement source, average length of stay, and days by level of care.
• WORKSHEET A. This form is used to show expenses.
• WORKSHEET B. This form is used to show overhead allocations.
• WORKSHEET D. This form is used to show a summary of costs.
Other forms include the balance sheet, which will be reported on Worksheet G; the statement of changes in fund balances, which will be found on Worksheet G-1; and the adjusted statement of patient revenues and net income, which will be found on Worksheet G-2.
"Medicare" within the cost report refers only to Medicare patients and the days of care provided while those patients had a valid Medicare hospice election, says Teresa Craig, CPA, vice president of finance and information systems at The Hospice of the Florida Suncoast in Largo, FL. The same applies to Medicaid, she says. Statistics for those patients cared for when not under the election should be included with statistics for days of care paid for by other payers. "Other," she says, refers to patients not making the hospice election under Medicare or Medicaid.
Reporting by metropolitan statistical area (MSA) is not included in the cost report. Because of questions and concerns raised by providers, HCFA eliminated separate cost reporting by MSA. This is probably helpful for hospices providing care in multiple MSAs, as the detail needed would have been difficult to compile. In Worksheet S-1, where HCFA asks in which county service was provided, the county where the administrative offices are located should be used.
Craig says the most difficult and timeconsuming portion of the cost report is Worksheet S-1, which must include data on days of care by reimbursement source, average length of stay, and days by level of care from each patient a hospice treated during the year. Hospices that haven’t been using that worksheet will have to go back and recapture the information.
"If you had more than 10 patients, it’s going to be difficult," she says.
Worksheet S-1 has three parts:
1. Part I, General Information. The worksheet provides lines to report location, date the hospice began operations, and when it was certified.
2. Part II, Enrollment Days. Programs will have to report days by level of care provided. Although continuous home care is reimbursed by the hour, it will be necessary to report the actual number of days the patient received continuous care, if at least eight hours of continuous care were provided each day. Unduplicated Medicare days, Medicaid days, and other payer days will be reported by number of days by level of care. In addition, the Medicare and Medicaid hospice benefit days will be reported separately for patients residing in a skilled nursing facility. Other payer sources are not reported by location of care, only level of care.
3. Part III, Census Data. The total number of patients receiving hospice care in the reporting period will be reported based on payer source. If a patient’s stay overlapped two reporting periods, the stay should be counted once in each reporting period. The patient who initially elects the hospice benefit, is discharged or revokes the benefit, and then elects the benefit again within a reporting period is considered to be a new admission with a new election, and should be counted twice. This is different than the reporting done for cap computation, in which each patient is only counted once as electing hospice care. However, in this cost report, average length of stay by patient includes all time periods under which the election was in place for that patient. All days are combined for the patient within each payer source to determine total length of stay for that patient by payer source.
Reclassification of Trial Balance Expenses
Worksheet A determines a hospice’s chart of accounts, and changes it may need to make to allocation.
"Careful review of the definitions and line items for the A worksheets will be important in determining your chart of accounts and changes you may need to make," says Craig. "The instructions on pages 38-9 through 38-16 are details of reporting you will provide. You should review your current chart of accounts and approach . . . cost allocation with these governmental definitions and requirements in mind. You may wish to share these line item definitions with all accounting staff involved in cost allocation and expense analysis."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content