Recipient must follow CMS instructions for completion of cost reports.
Under cost-based reimbursement, the payer agreed to reimburse the provider for the costs incurred in providing services to the insured population. If the full cost were reimbursed based upon this method, there is nothing eligible to report as a Provider Relief Fund or ARP Rural expense attributable to coronavirus because the expense was fully reimbursed by another source. Provider Relief Fund and/or ARP Rural payments cannot be used to cover costs that were reimbursed from other sources or that other sources are obligated to reimburse. Therefore, if Medicare or Medicaid made a payment to a provider based on the provider’s Medicare or Medicaid cost, such payment generally was considered to fully reimburse the provider for the costs associated with providing care to Medicare or Medicaid patients and no payment from the Provider Relief Fund or ARP Rural Distribution would be available for those identified Medicare and Medicaid costs. Per its authorizing statutes, Provider Relief Fund resources may only be used for allowable expenses and lost revenues attributable to coronavirus, and may only be reimbursed once. Reporting Entities should work with their accountants and maintain documentation demonstrating that any reported health care expenses that Provider Relief Fund and/or ARP Rural payments were applied to were not reimbursed by any other source, or obligated to be reimbursed by another source.
However, in cases where a ceiling is applied to the cost reimbursement, or the costs were not reimbursed under cost-based reimbursement (such as costs for care to commercial payer patients), and the reimbursed amount by Medicare or Medicaid does not fully cover the actual cost, those non-reimbursed costs were eligible for reimbursement under the Provider Relief Fund or ARP Rural Distribution.
(Updated 10/27/2022)