FQHC Cost Report Preparation Checklist

This checklist covers the data-gathering and verification work needed before preparing the FQHC Medicare cost report, including visit counts, revenue detail, expense support, and reconciliation items. It is meant to organize the source documents and review steps that feed CMS Form 222-92, not to replace the final report itself. Use it to make sure each required data set has an owner, a source, and a verification step.

It is typically used annually, aligned to the cost report cycle, but many FQHCs run parts of it quarterly or monthly to avoid year-end scrambling. A recurring cadence helps surface missing visit logs, payroll allocations, or revenue reconciliations while records are still easy to correct. If your finance team closes books monthly, you can adapt the checklist to a monthly pre-close review and keep the annual version as the final prep pass.

The DRI is usually a finance lead, reimbursement manager, or cost report preparer, with supporting tasks assigned to billing, revenue cycle, operations, and clinic managers. The best setup is to assign each checklist item to the person who can verify the source record directly. Avoid assigning everything to one person if they do not control the underlying data.

It is designed for Medicare cost report preparation, but the same structure can help with internal reimbursement reviews and audit readiness. The checklist focuses on the records and reconciliations that support the report, so it is useful before filing and during pre-submission review. If you need a broader compliance audit checklist, this template is narrower and more report-specific.

Common failures include missing encounter support, mismatched visit counts between systems, incomplete payroll or fringe allocations, and revenue not tied back to the general ledger. Another frequent issue is treating every discrepancy as blocking when some items can be documented and resolved later. This checklist helps separate blocking items from non-blocking follow-ups so the report can keep moving.

Customize the checklist to match your service lines, cost centers, payer mix, and any contracted or shared services that affect allocation. Add checklist items for the systems you actually use, such as EHR, billing, payroll, and general ledger exports, and remove items that do not apply. Keep each item independently verifiable so the answer is clearly yes, no, or N/A.

Yes, it works well as a task template that links out to source systems, exported reports, and supporting documents. Many teams attach the checklist item to the relevant report, spreadsheet, or folder so the reviewer can verify the evidence without hunting across systems. If you use integrations, map each task to the exact export or record set needed for the cost report.

An ad-hoc approach makes it easy to miss a source file, duplicate work, or lose track of who verified what. A checklist creates a repeatable sequence with clear ownership, priority, and completion criteria, which is especially useful when multiple departments contribute data. It also gives you a single place to track blocking issues before they become filing delays.