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Rural Hospital Cost Reports

Rural Hospital

Rural hospitals are instrumental in providing critical healthcare services to 46 million Americans that live in 97% of the country’s land mass. This responsibility is often burdened by many challenges including provider and labor shortages and lower patient volumes to name a few, which results in negative operating margins in the majority of rural hospitals.

One opportunity to increase your operating margin is with the Medicare and/or Medicaid cost reports. Through these reporting requirements your calculated costs play a significant role in your reimbursement. In rural hospitals it is not uncommon for 50-70% of your patients to have Medicare or Medicaid, including their Managed Care plans, as either a primary or secondary insurance coverage. Ensuring your cost reports are accurately reflecting your costs for the services provided is critical to obtain the reimbursement you are owed. Remember there can also be additional reimbursement with other subunits of your hospital as well through their different cost reports.

When reviewing your cost reports, the end goal should be that the appropriate reimbursement is identified and obtained. With rural hospitals, a small change to correct the cost report(s) can result in a large change in reimbursement. Don’t underestimate the value of ensuring your cost reports accurately reflect your operations.

Thank you to all rural healthcare providers in your challenging role of providing essential and accessible healthcare services to rural Americans.


Caren Puvalowski, CHFP is the Rural Healthcare Reimbursement Manager for The Rybar Group. She offers expertise in the area of Rural Hospital financial, accounting, revenue cycle and reimbursement experience. Her hands-on experience working in a variety of roles in the finance departments of CAHs, including multiple years as a Chief Financial Officer, allows her to identify both present and future reimbursement and payment opportunities.

Reach out to Caren for more information regarding cost report and other reimbursement opportunities for CAH. She can be reached at 810-853-6185 or via email at 

Focusing exclusively in the healthcare arena, The Rybar Group brings in-depth industry knowledge to help clients create solutions designed to identify opportunities for revenue generation, isolate root causes for underperformance, accelerate cash in the door and support long-term margin improvement. The Rybar Group does not dabble in reimbursement and revenue cycle solutions; we specialize in it.