Skilled Nursing & Long-Term Care
Specialized accounting, tax, and advisory for skilled nursing, assisted living, and long-term care providers — from cost reports to the boardroom.
Overview
Few industries live and die by their numbers the way long-term care does. Reimbursement rules shift, labor costs climb, and a single misstated cost report can follow an operator for years. Pease Bell has spent decades in skilled nursing, long-term care, and senior living — working alongside owners, operators, and management companies across Ohio and nationwide to protect reimbursement, satisfy lenders and regulators, and turn financial data into decisions you can act on. We understand the economics behind your beds, your payor mix, and your cost reports, so the advice you get is grounded in how your business actually runs.
How we help long-term care operators
One team across cost reporting, assurance, tax, and transactions — so the numbers stay consistent from the cost report to the tax return to the sale.
Medicare & Medicaid cost reports
Preparation, review, and support for Medicare and state Medicaid cost reports — filed accurately and on time, with an eye on the reimbursement impact of every allocation and related-party disclosure.
Financial statement audits & reviews
Audits, reviews, and compilations that lenders, HUD, and equity partners trust — planned early and delivered without the last-minute fire drill.
Reimbursement & rate consulting
Modeling and analysis around case mix, occupancy, and state rate methodologies so you understand what drives your reimbursement before the rules change it.
Tax planning & compliance
Entity structuring, real-estate and operations tax strategy, and multi-state compliance built for the way ownership and management companies are actually organized.
Transaction advisory
Quality-of-earnings, due diligence, and structuring support when you buy, sell, or recapitalize facilities — so surprises surface before closing, not after.
Outsourced accounting & CFO support
Monthly close, controller, and CFO-level support for operators who want reliable numbers without building a full internal accounting department.
Contact Us
Tell us about your organization and a member of our long-term care team will be in touch.
The pressures we help you manage
Long-term care finance is a moving target. We help operators stay ahead of the issues that most often put reimbursement and margins at risk:
- ✓Reimbursement exposure — cost reports and rate methodologies that leave money on the table or invite audit adjustments.
- ✓Related-party complexity — management companies, real estate, and inter-entity loans that must be disclosed and eliminated correctly.
- ✓Rising labor & agency costs — staffing pressure that reshapes both your cost report and your operating model.
- ✓Lender & HUD requirements — audited financials, surplus-cash calculations, and covenant reporting on tight deadlines.
- ✓Ownership change — diligence, working-capital, and structuring questions every time a facility trades.
Why operators choose Pease Bell
A genuine niche, not a side practice
Long-term care is one of our deepest specialties. You work with people who already speak the language of PDPM, case mix, and cost reports — not generalists learning your industry on your time.
One firm, end to end
Cost reports, audits, tax, HUD, and transactions live under one roof, so your data stays consistent and your advisors actually talk to each other.
Full service, boutique touch
You get the depth of a Top 200 firm with partners who stay close to the work and answer the phone when the rules change.
Healthcare & Long-Term Care Team
Kuno S. Bell, CPA, J.D.
Managing Partner
Dean Benedetto, CPA, MBA
Manager
Sherri Blackwelder, CPA
Partner
Aaron Cherr, CPA
Manager
Grady McMichen, J.D.
Tax Associate
Ron Misconish, CPA
Partner
Mark E. Noble, CPA
Partner
Ryan C. Praschan, CPA
Partner
Beth Reimer, CPA, MBA
Partner
Kevin Schule, CPA, MBA
Director
Yisroel Segal, CPA
Partner
Christopher J. Szuch, CPA
Partner
Joel M. Ungar, CPA
Director
Featured Insights
Long-term care insights from our team
Practical guidance on the reimbursement, reporting, and compliance issues facing skilled nursing and senior living operators.
- Healthcare
Related-Party Loans and Advances: Considerations for Operations and Reporting in HealthcareHow related-party loans and advances should be structured, disclosed, and reported.
- HUD Section 232
Now That I Have a HUD Section 232 Mortgage — What’s Next? (Part 2)Surplus-cash calculations and ongoing HUD reporting obligations after closing.
- Medicaid
Medicaid Work Requirements: What the Interim Final Rule MeansPolicy shifts that ripple through long-term care reimbursement and eligibility.
- Single Audit
The 2026 Uniform Guidance OverhaulChanges to the single-audit threshold and compliance supplement that affect federally funded providers.
Skilled nursing & long-term care accounting FAQs
What is a Medicare or Medicaid cost report, and why does accuracy matter so much?
A cost report is the annual filing that reconciles a facility’s costs to the care it delivered and, in many states, helps set future reimbursement rates. Because rates and audit adjustments flow from these filings, small errors in cost allocation, related-party disclosure, or statistical data can affect reimbursement for years. We prepare and review cost reports with that downstream impact in mind.
Do you work with multi-facility operators and management companies?
Yes. Much of our work is with operators, management companies, and ownership groups that run multiple facilities across several states. We’re comfortable with the related-party structures, inter-company transactions, and consolidated reporting these organizations require.
Can you handle both the audit and the tax work?
We can. Cost reporting, audit and assurance, tax, HUD, and transaction advisory all sit within one firm, which keeps your financial data consistent across filings and gives you a single team that understands the whole picture. Where independence rules apply to an audit engagement, we structure the relationship accordingly.
We have a HUD Section 232 mortgage. Can you help with the reporting?
Yes. We work extensively with HUD-financed operators on audited financial statements, surplus-cash calculations, and the ongoing reporting HUD requires. See our HUD services for more.
Do you only serve skilled nursing, or also assisted living and senior housing?
We serve the full long-term care and senior living spectrum — skilled nursing, assisted living, memory care, CCRCs, and related senior housing — as well as the real estate and management entities that support them.
Are you able to serve facilities outside Ohio?
Yes. Pease Bell is a Cleveland-based, Top 200 U.S. firm serving clients in all 50 states. We regularly handle multi-state reimbursement and compliance for operators well beyond Ohio.