Medicare Reimbursement Guide
Medicare Reimbursement Guide for Healthcare Providers Medicare reimbursement touches almost all healthcare organizations, and its importance is especially felt by small and mid-sized ones such as home health agencies, hospices, physical therapy providers, outpatient clinics, and independent medical practices. While Medicare often gets discussed in the context of hospitals, the same rules, codes, timelines, and […]
Understanding Medicare DRG: Key Insights for Better Healthcare Costs
Since the early 1980s, Medicare’s prospective payment systems have transformed how healthcare providers are reimbursed for patient care. Central to that evolution is the Diagnosis Related Group, or DRG, system, a framework designed to standardize hospital payments and encourage efficiency. While the DRG model began in hospital settings, its logic now extends to nearly every […]
Understanding Medicare PPS: What Healthcare Providers Need to Know
In 1983, Medicare introduced a fixed payment model for hospitals known as the inpatient prospective payment system (IPPS). That change marked a turning point as it shifted reimbursement from cost-based to diagnosis-based payments. Over the decades, that same concept has been extended into the post-acute and community setting: skilled nursing facilities (SNFs) in 1998, home […]
SNF Related Party Cost Reporting: Insights and Guidance
Beyond the immediate demands of resident care, running a skilled nursing facility (SNF) today requires mastering complex financial reporting. This reporting is not mere bookkeeping; it directly determines Medicare reimbursement and compliance status. Among the most scrutinized areas is the proper disclosure and handling of related party transactions. These common transactions occur between an SNF […]
How SNF Cost Reports Impact Medicare Reimbursement: Key Insights
Running a skilled nursing facility (SNF) means balancing patient care, staffing pressures, and an increasingly complex reimbursement system. Among the many compliance responsibilities, few are as consequential as the SNF cost report. This annual filing meets a CMS requirement and determines how much a facility is reimbursed under Medicare, affects audit outcomes, and plays a […]
RHC vs FQHC Cost Reporting: Key Differences and Emerging Funding Realities
Running a healthcare facility in an underserved area comes with an unusual blend of mission-driven purpose and administrative complexity. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) both exist to expand access to primary care, yet their regulatory and financial frameworks are far from identical. One of the most significant areas of difference […]
Guide to RHC Cost Report Audit Compliance with Best Practices
Running a Rural Health Clinic (RHC) requires balancing patient care with a maze of administrative responsibilities. Among the most critical is making sure your clinic’s Medicare cost reports are accurate, timely, and fully in compliance. In this guide, we cover the fundamentals of RHC requirements, common audit challenges, and offer our readers some best practices […]
Mastering RHC Revenue Cycle Management for Financial Health
Running a Rural Health Clinic (RHC) means balancing the realities of patient care with the complex demands of financial management. For independent and provider-based RHCs alike, one of the most important pillars of sustainability is revenue cycle management (RCM). While cost reports determine how Medicare reimburses clinics for services provided, RCM is what keeps the […]
Essential Guide to Rural Health Clinic Cost Reports
Rural Health Clinics (RHCs) occupy a unique and vital place in America’s healthcare landscape. Established to expand access in underserved areas, they provide essential services to communities that might otherwise lack reliable care. Yet, like other Medicare-certified providers, RHCs face the same administrative reality: every year, they must file a Medicare cost report using a […]
Nursing Home Cost Reports: Compliance and Reimbursement
Introduction to Cost Reporting More than 15,000 Medicare-certified nursing homes file a Medicare Cost Report each year, and each submission plays a role in shaping billions of dollars in reimbursement. This detailed document allows the Centers for Medicare & Medicaid Services (CMS) to monitor spending, verify reimbursement, and ensure transparency across the industry. Medicare Administrative […]