Form preview

Get the free FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES - hfs i...

Get Form
This document serves as a financial and statistical report for long-term care facilities in Illinois, requesting necessary information to ensure compliance with the state's healthcare and family services
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign financial and statistical report

Edit
Edit your financial and statistical report form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your financial and statistical report form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing financial and statistical report online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use the services of a skilled PDF editor, follow these steps below:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Upload a file. Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. Then click Edit.
3
Edit financial and statistical report. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
With pdfFiller, it's always easy to work with documents.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out financial and statistical report

Illustration

How to fill out FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES

01
Gather all necessary financial documents for the reporting period, including income statements, balance sheets, and supporting financial data.
02
Identify the reporting requirements specific to the long-term care facility, including any state or federal guidelines.
03
Fill out the demographic information at the top of the report, including the facility's name, address, and contact information.
04
Complete the revenue section by listing all income sources, such as patient fees, government reimbursements, and any other financial contributions.
05
Detail the expenses by categories like personnel costs, operating supplies, and administrative expenses, ensuring all costs are accurately recorded.
06
Calculate total revenues and total expenses to determine the net income or loss for the reporting period.
07
Review the report for accuracy, ensuring all calculations are correct, and properly categorized.
08
Submit the completed report to the necessary regulatory agency by the required deadline.

Who needs FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES?

01
Long-term care facilities that provide services to seniors and individuals with disabilities need the FINANCIAL AND STATISTICAL REPORT (COST REPORT) to comply with state and federal regulations.
02
Healthcare administrators and financial managers within these facilities require the report to assess financial health and operational efficiency.
03
Government agencies and funding organizations use the report for oversight and to allocate funding appropriately.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.5
Satisfied
30 Votes

People Also Ask about

Nursing home costs by state StateShared room per dayPrivate room per day California $322 $400 Colorado $282 $320 Connecticut $453 $499 District of Columbia $345 $34547 more rows • Sep 26, 2023
The Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS), administers Medicare, Medicaid, the Children's Health Insurance Program (CHIP), the Clinical Laboratory Improvement Amendments (CLIA), and parts of the Affordable Care Act (ACA) ("Obamacare").
How to Create a Cost Report? Creating a cost report requires gathering data from multiple sources such as invoices, contracts, and timesheets. This data should then be organized into categories such as labor costs, materials, and overhead expenses.
Nursing homes and assisted living facilities Nursing homes represent the most expensive long-term care option, with private rooms costing an estimated 10,646 U.S. dollars per month in 2024. Semi-private rooms are slightly more affordable at 9,277 U.S. dollars monthly.
Cost reports are generally prepared by Cost Consultants and sometimes Quantity Surveyors to keep the client informed about the Project Cost. A cost report includes the costs incurred by the time of reporting and all the future costs (Forecast Cost) that is likely to be incurred during the rest of the project.
Each year, Medicare Part A providers must submit an acceptable Medicare Cost Report (MCR) package to their Medicare Administrative Contractor (MAC) for the purposes of determining their Medicare reimbursable cost. The MCR package consists of a variety of cost report materials.
How to Create a Cost Report? Creating a cost report requires gathering data from multiple sources such as invoices, contracts, and timesheets. This data should then be organized into categories such as labor costs, materials, and overhead expenses.
A Medicare Cost Report (MCR) is a financial account submitted from Medicare-certified entities, such as skilled nursing facilities, hospitals or hospices, to a Medicare Administrative Contractor (MAC). Each entity updates its report at the end of its fiscal year, and MCRs publish quarterly.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The Financial and Statistical Report (Cost Report) for long-term care facilities is a comprehensive document that collects financial and operational data from these facilities. It is used to assess the cost of services provided, reimbursement rates, and overall financial health.
Long-term care facilities that receive Medicare or Medicaid reimbursements are typically required to file the Financial and Statistical Report. This includes nursing homes, skilled nursing facilities, and other similar institutions.
To fill out the Financial and Statistical Report, facilities should gather financial data, including revenue, expenses, and operating statistics. They need to accurately complete all sections of the report according to the guidelines provided by the Centers for Medicare & Medicaid Services (CMS).
The purpose of the Financial and Statistical Report is to evaluate the financial performance of long-term care facilities, ensure compliance with federal regulations, and assist in determining reimbursement rates for services provided.
The report must include detailed information such as total operating revenue, total expenses, patient statistics, staffing levels, and other financial metrics relevant to the operations of the long-term care facility.
Fill out your financial and statistical report online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.