CHA News

CMS Releases Updated Medicare Cost Report Instructions 

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On Dec. 29, the Centers for Medicare & Medicaid Services released updated Medicare cost report instructions for acute care hospitals.  

Among other changes, the revised instructions: 

  • Add/revise exhibits for reporting Medicare bad debt, Medicaid eligible days, charity care, and total bad debts 
  • Include revisions to Worksheet S-10 
  • Implement fiscal year 2023 inpatient prospective payment system final rule changes, including direct graduate medical education changes related to the decision in Hershey v. Becerra, which was positive for teaching hospitals  
  • Implement Sections 126 (new Medicare funded graduate medical education slots), 127 (rural training track), and 131 (adjustment to intern and resident cap for certain hospitals) of the Consolidated Appropriations Act of 2021, which are related to graduate medical education. 
  • Identify permanent adjustments to the Tax Equity and Fiscal Responsibility Act target amount per discharge 
  • Identify providers purchasing greater than 50% of their professional services from an unrelated organization located outside the hospital’s local area labor market 
  • Identify the number of temporary expansion COVID-19 public health emergency acute care beds 
  • Add Worksheet D-6, Parts I through IV, to compute allogeneic hematopoietic stem-cell transplantation acquisition costs 
  • Add Worksheet E-5 for the contractor to report the outlier reconciliation amount during cost report tentative settlement 

The revised instructions are effective for cost reporting periods that began on or after Oct. 1, 2022. Many of these changes were proposed through the paperwork reduction act process. CHA’s comments on the proposed changes are available on its website