Hospitals
Cost reports, audits, Form 990 support, and reimbursement analysis for community hospitals and critical access hospitals.
Overview
Community and critical access hospitals operate on thin margins with revenue that depends heavily on Medicare, Medicaid, and commercial payer contracts. The Medicare cost report is central to that picture, and for critical access hospitals it directly drives cost-based reimbursement. Hospitals also face audit expectations from boards, bondholders, and lenders, and nonprofit hospitals carry additional public reporting through Form 990. Pease Bell works with hospitals on the accounting, audit, and reimbursement work that connects these requirements.
Our healthcare team has served providers for about 20 years and works with roughly 600 facilities in about 35 states. For hospitals, we prepare and review Medicare and Medicaid cost reports, audit financial statements, and help nonprofit hospitals with Form 990 reporting at a general level. We also analyze reimbursement and revenue cycle data so leadership can see where payments, contractual adjustments, and settlements are moving and why.
How We Help Hospitals
Medicare Cost Reports
Preparation and review of hospital Medicare cost reports, including cost allocation, statistical data, and supporting schedules, with help responding to Medicare Administrative Contractor reviews and audits.
Medicaid Cost Reports
Preparation of state Medicaid cost reports and related filings, coordinated with your Medicare cost report and general ledger so figures are consistent across programs and supported when state agencies review them.
Hospital Financial Audits
Audits of hospital financial statements for boards, bondholders, and lenders, with focus on patient revenue, contractual allowances, third-party settlements, and other significant estimates that drive reported results.
Nonprofit Hospital 990 Support
Form 990 preparation and review support for tax-exempt hospitals, including the hospital-specific schedule and community benefit information, coordinated with your audited financial statements so public reporting is consistent.
Reimbursement Analysis
Analysis of Medicare, Medicaid, and commercial reimbursement to help leadership understand payment trends, estimate settlements, and evaluate how cost report and payer contract decisions affect revenue over time.
Revenue Cycle Review
Review of billing, collections, and contractual adjustment data to identify where revenue is lost or delayed and where reported net patient revenue may need closer support.
Challenges We Help Hospitals Address
- ✓Cost-based reimbursement that depends on an accurate, well-supported cost report
- ✓Estimating third-party settlements and contractual allowances with confidence
- ✓Public reporting and community benefit expectations for nonprofit hospitals
- ✓Payer mix shifts that compress already thin operating margins
- ✓Revenue cycle gaps that delay cash and complicate year-end reporting
Featured Insights
Frequently Asked Questions
Why is the Medicare cost report important for hospitals?
The Medicare cost report summarizes a hospital’s costs, statistics, and charges, and Medicare uses it to settle payments and set future rates. For critical access hospitals, which are paid on a reasonable cost basis, the cost report directly determines reimbursement. Errors or weak support can mean lost revenue or adjustments on review, so careful preparation matters.
What is a critical access hospital?
A critical access hospital is a Medicare designation for small, generally rural hospitals that meet federal requirements on bed count, location, and services. Instead of standard prospective payment rates, these hospitals receive cost-based reimbursement for many Medicare services. That makes accurate cost reporting especially important, and it is a regular part of our hospital work.
Do nonprofit hospitals file Form 990?
Yes. Tax-exempt hospitals generally file Form 990, including a schedule specific to hospital organizations that covers community benefit and related requirements under IRC Section 501(r). That information is public, so it should be consistent with your audited financial statements. Pease Bell can help prepare and review this reporting at a general level.
Can a CPA firm help with hospital reimbursement?
Yes. A CPA firm with healthcare experience can analyze cost reports, payer data, and settlements to help a hospital understand how it is being paid and where revenue may be at risk. Pease Bell combines cost report preparation, audit, and reimbursement analysis so leadership gets one consistent view of the numbers.
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