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CAH Finance 101 Manual

June 2017
National Rural Health Resource Center (The Center)

This manual was developed for use by state Medicare Rural Hospital Flexibility (Flex) Program personnel as well as staff and boards of critical access hospitals (CAHs). The content is designed to be as non-technical as possible and to provide answers to frequently asked questions regarding CAH finance and financial performance. A few examples of questions included in the manual:

  • What is the Medicare swing bed program?
  • What is CAH cost-based reimbursement?
  • If CAHs are reimbursed at 101%, why might they not make a profit?
  • If a CAH has a rural health clinic attached, how do they bill for those services and file their expenses?
  • Why is a review of the cost report important?

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $957,510 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.