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Critical Access Hospital Cost Reporting Program Completed

Oct 15, 2025

This summer the North Dakota Medicare Rural Hospital Flexibility (Flex) Program filled a need for many Critical Access Hospitals (CAHs) by sponsoring a cost report strategy/compliance review. Nearly one third of the 37 North Dakota CAHs submitted an application to be selected for this opportunity, which only had four spots available, showing a growing need in the state.

CAHs submit a cost report annually to Medicare, detailing the costs incurred in delivering services to patients over the past year. The cost report strategy/compliance review activity provided an in-depth review of the CAHs current cost report to identify any risks, opportunities, and optimization of Medicare reimbursement. Eide Bailly facilitated the activity.

The program included:

  • A review of current reporting elections/strategies to identify risks and opportunities to improve data collection, correct errors in reporting, and considerations for requesting/electing alternative methodologies for reporting and allocating of costs.
  • A review of organizational services and structures to determine if there are opportunities to make changes in organizational operations that would allow for enhanced reimbursement opportunities in the cost report.

Megan Rath, CFO of South Central Health out of Wishek, shared the impact the activity had on the hospital. "The cost report review was such a great experience for South Central Health. Our session with Eide Bailly helped us better understand our compliance risks, identify opportunities for improvement, and ensure we're staying compliant with current regulations. The guidance we received will strengthen our financial planning and ultimately support our ability to continue providing high-quality care in our community."

St. Luke's Medical Center, in Crosby, also participated in the activity. "The review was a great opportunity for St. Luke's Medical Center," shared CEO Jody Nelson. "It helped us take a closer look at how we report our costs and showed us some ways to improve and make sure we're getting the reimbursement we're eligible for. Opportunities like this make a big difference for small hospitals like St. Luke's.

North Dakota Flex Program

Anna Walter

The Flex Program is housed at the Center for Rural Health (CRH), within the University of North Dakota School of Medicine & Health Sciences. Flex is a state-based partnership that works with and assists all rural hospitals to stabilize and sustain their local healthcare infrastructure.

"The North Dakota Flex Program was happy we were able to offer this opportunity for several CAHs," said Anna Walter, project coordinator at CRH, "to help them ensure regulatory accuracy, maximize reimbursements, and strengthen financial decision-making."