Please help me, as the cost report is going to be due soon. First of all, let me give some background. I was hired in July to replace the MSO that had been fired. The problem is, I thought I was being hired to be a biller, my expertise is only in billing, my salary is a biller's salary, but this MD and his so-called Administrator (who clearly is really nothing but a DON) think that I am responsible for everything the MSO was responsible for. They don't seem to realize it was a MANAGEMENT Services Organization, not a BILLING services organization.

Among other things, they are convinced it is my responsibility to complete the Cost Report - after all, the MSO did it before and I have replaced the MSO.

I think I can very easily squirm out of all of it EXCEPT the bad-debt portion. After all, I can truly say I have no way of knowing what the center's salaries are, but I would have a hard time playing dumb about bad debt.

As usual, the various CMS and FI sites don't go into the "what ifs" and almost all of our bad-debt scenarios are "what ifs". I have Googled this a hundred times, but without knowing precisely which search terms to use it is hard to find an answer of this nature.

For instance, I am understanding that only the deductible and coinsurance of the composite rate can be declared on the cost report. So what about this scenario - the coinsurance on treatments only is $330, but the total coinsurance on the entire claim is $470, and of that $400 gets paid. So, that remaining $400, is it prorated between treatment and non-treatment, meaning that $165 gets applied to the treatment coinsurance and $235 gets applied to all other and therefore $165 can be included in the cost report bad debt total? Or is it applied to treatment first and therefore since $330 is less than $400 then none of it goes on the cost report?

Also, I am understanding that as long as a patient is making payments on their balance that none of it is considered "bad debt". That would make sense in an acute setting, but of course my patients' coinsurance routinely ranges from $300 - $600 per month, and they are paying a whopping $10-$20 per month. So, does that mean that the unpaid roughly $5,000 can never be counted as bad debt on the cost report?

Thanks for any and all help that anyone can give. And a website backing your answer up will help becuase I have a feeling I am going to have to justify my figures.

I don't know anything about cost reports, but you might try this web site:

www.costreports.com

Good luck.

Thanks so much for your quick reply, but I'm not looking for software to prepare the cost report. I'm looking for answers so that the cost report can be prepared. ]

Anyone else, who actually has an answer to my question? Someone who DOES know about cost reports?

Sorry about the slow reply. I've been swamped doing cost reports! Thank you for the good detailed questions on bad debt, which allows for more defined answers. I am not aware of written instructions in the regs that specifically would answer your questions, so I would prorate the unpaid deductible between treatment and ancillary, document you did so, and claim that amount on the cost report. Much of this is up to the discretion of the auditing Medicare Intermediary (scarey!) but if you have documentation, you should be fine. Make sure you have documented your three attempts at collecting. They often ask for that documentation as proof before they pay you for the bad debt in the cost report settlement. On the patient paying a small percentage of the balance, you will eventually be able to claim the bad debt in the year you finally write it off, once the patient fails to pay for some reason or another (death, etc.). If you have further questions, feel free to call me at 800-800-3642, or e-mail feigal@hdsinfo.com.