Cost Report Preparation
Accurate Medicare and Medicaid cost reports, prepared and defended — so your facility captures every dollar it’s entitled to and stays in compliance.
Overview
Cost reporting is complex, high-stakes, and unforgiving of errors. From our Cleveland, Ohio headquarters, Pease Bell, CPAs prepares, reviews, and defends the Medicare and Medicaid cost reports that drive reimbursement for healthcare providers in all 50 states. We work end to end across skilled nursing facilities, hospitals and critical access hospitals, home health, hospice, and FQHCs and RHCs, handling cost allocation, statistical data, related-party disclosures, and wage index review with the specialized knowledge healthcare reimbursement demands. When a desk review or audit follows, we stand behind the filing, so nothing your organization is entitled to is left on the table.
What we deliver
End-to-end cost report preparation and review that protects reimbursement and holds up under scrutiny.
Medicare cost reports
Preparation and filing of Medicare cost reports on current CMS forms, with accurate cost allocation, worksheet ties, and statistical data that support your reimbursement position.
Medicaid cost reports
State-specific Medicaid cost reports prepared to each program’s formats and rate-setting rules, so your filings reconcile to the general ledger and reflect allowable costs correctly.
SNF & long-term care reports
Skilled nursing and long-term care cost reports with careful treatment of nursing hours, ancillary costs, and PDPM data, tied to the reimbursement drivers that matter for your facility.
Hospital & CAH reports
Cost reports for hospitals and critical access hospitals, including step-down allocations, DSH and GME data where applicable, and reconciliation to audited financial statements.
Wage index review
Review and support of wage index data before submission and during CMS review windows, helping ensure hours and dollars are reported accurately to protect area reimbursement.
Audit support, reopenings & appeals
Representation through MAC desk reviews and audits, plus reopenings and appeals, where we respond to information requests and challenge proposed audit adjustments on your behalf.
Contact Us
Tell us about your business and a member of our team will be in touch.
Who we prepare cost reports for
We serve providers across the healthcare reimbursement landscape, tailoring each engagement to the forms, deadlines, and program rules that apply to your setting.
- ✓Skilled nursing & long-term care — SNFs and nursing facilities filing Medicare and state Medicaid cost reports where nursing hours, ancillary costs, and case-mix data shape reimbursement.
- ✓Hospitals & critical access hospitals — Acute and CAH providers needing accurate step-down allocations, statistical data, and reconciliation to audited financials.
- ✓Home health & hospice — Agencies with visit and cost data that must be allocated and reported correctly under Medicare and applicable state programs.
- ✓FQHCs & RHCs — Federally qualified health centers and rural health clinics filing cost reports that set encounter and per-visit reimbursement rates.
- ✓Providers under review or appeal — Organizations facing a desk review, audit adjustment, reopening, or appeal that need experienced support defending a filed report.
Why providers choose Pease Bell for cost reporting
Reimbursement is our focus, not an afterthought
Cost reporting is specialized work, and we treat it that way. Our team knows how allocation choices, statistical data, and related-party disclosures translate into dollars, so accuracy protects both compliance and your rate.
We defend what we file
A cost report is only as good as it holds up under review. We stay with you through desk reviews, audits, reopenings, and appeals, responding to MAC requests and challenging proposed adjustments that are not supported.
A boutique touch with full-service depth
As a Top 200 U.S. CPA firm with 150-plus professionals serving clients in all 50 states, we pair specialized reimbursement knowledge with audit, tax, and HUD expertise under one roof, the way Full Service, Boutique Touch is meant to work.
Our cost report process
A disciplined workflow that turns your financial and statistical data into an accurate, defensible filing.
Step 1
Gather & reconcile
We collect your trial balance, statistical data, and payroll and census records, then reconcile them to the general ledger and identify related-party relationships that require disclosure.
Step 2
Prepare & review
We prepare the cost report on the correct CMS or state forms, allocate costs accurately, review the wage index and statistical inputs, and check every worksheet before you sign and file.
Step 3
Defend & follow through
After filing, we support you through desk reviews and audits, respond to information requests, and pursue reopenings or appeals to protect the reimbursement your data supports.
Featured Insights
Cost reporting & reimbursement insights
Guidance from our healthcare team on the rules and reviews that shape your reimbursement.
- Related-party rules
Related-party loans and advances in healthcareExplains related-party disclosure considerations that directly affect cost report allowable costs.
- SNF cost reports
Related-party costs on the SNF cost reportDetails how related-party transactions are treated on skilled nursing facility cost reports.
- New CMS form
SNF Medicare cost report on CMS-2540-24Walks through changes on the updated SNF Medicare cost report form.
- Reimbursement policy
PDPM case-mix creepExplains PDPM case-mix trends that shape SNF reimbursement and cost report data.
- HUD financing
After a HUD Section 232 mortgage: what’s nextConnects senior-care HUD financing to ongoing reporting obligations for facilities.
Cost report preparation FAQs
What is Medicare & Medicaid cost report preparation?
Medicare and Medicaid cost report preparation is the process of compiling a provider’s financial and statistical data into the standardized forms CMS and state agencies require to determine reimbursement. It involves reconciling costs to the general ledger, allocating expenses across cost centers, disclosing related-party relationships, and reporting statistical and wage data accurately, so the filing supports the reimbursement the provider is entitled to and withstands later review.
Who is required to file a cost report?
Most Medicare-certified institutional providers must file an annual cost report. This includes skilled nursing facilities, hospitals and critical access hospitals, home health agencies, hospices, and FQHCs and RHCs. Many state Medicaid programs require their own cost reports as well. Filing deadlines are generally tied to your fiscal year end, and late or incomplete filings can trigger payment suspensions, so timely, accurate preparation matters.
Why does cost report accuracy affect reimbursement?
Because the data on your cost report feeds directly into how you are paid and audited. Cost allocations, statistical data, and wage index inputs help set or settle your reimbursement, and errors can leave allowable costs unclaimed or invite adjustments. Accurate preparation captures what you are entitled to, while sloppy filings expose you to audit adjustments, recoupments, and, in some cases, compliance risk.
What are related-party disclosures on a cost report?
Related-party disclosures identify transactions between your organization and entities under common ownership or control, such as management companies, real estate holders, or affiliated lenders. Cost report rules generally limit related-party costs to the related party’s actual cost rather than the amount charged. Reporting these relationships correctly is essential, because missed or misstated disclosures are a common source of audit adjustments in skilled nursing and long-term care.
Can you help if we are facing a desk review, audit, or reopening?
Yes. We support providers through Medicare Administrative Contractor desk reviews and audits, and we handle reopenings and appeals of settled reports. That includes responding to information requests, reconstructing support for reported costs, and challenging proposed adjustments that are not supported by the rules. Whether or not we prepared the original filing, we can step in to defend your reimbursement position.
Do you prepare cost reports for providers outside Ohio?
Yes. While Pease Bell is headquartered in Cleveland, Ohio, we prepare Medicare and Medicaid cost reports for healthcare providers in all 50 states. Medicare forms follow national CMS standards, and we prepare state Medicaid cost reports to each program’s specific formats and rate-setting rules, so multi-state operators can rely on consistent, coordinated cost reporting across their portfolio.