Nursing Home Bookkeeping Built Around Your Cost Report and Medicaid Rate
Booxmax is a bookkeeping, payroll, and advisory firm.
In many states your Medicaid per-diem is set from your CMS-2540 cost report, and that report is only as accurate as your cost allocation and your payer-mix day counts. We keep those books. Your preparer files the report.
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A SNF cost report is built from your books, and in many states so is your rate
Medicare pays a skilled nursing facility a prospective rate, but Medicaid is different. In many states your Medicaid per-diem is calculated from your cost report: total allowable costs, divided across total resident days, multiplied by your Medicaid days. So a misallocated cost center or a miscounted Medicaid day does not just create an audit problem. In a cost-based state, it can flow into a per-diem that understates what your care actually costs, for the whole rate year. That is why the bookkeeping under the cost report is not clerical work.
Payer mix is a daily number, not a year-end guess
The rate math depends on Medicaid days against total resident days. That census and payer mix has to be captured daily and kept clean, or the day counts that drive your rate get reconstructed from memory at filing time. We keep the census and the payer-mix data (Medicaid, Medicare, Medicare Advantage, managed care, private) current month to month, so the numbers your preparer files are the numbers that happened.
The cost report just got harder
For cost-reporting periods ending on or after September 30, 2025, the SNF cost report is moving from the CMS-2540-10 to the new CMS-2540-24 forms (per CMS guidance), the first revision in fifteen years. The new forms ask for data many facilities never tracked separately, including Medicare Advantage and Medicaid HMO days and admissions detail. Books set up for the old form will not produce the new one cleanly. We set up your books to the line items the new forms require.
What we keep, every month
- Books with cost allocation kept clean for the cost report that feeds your rate.
- Census and payer-mix day counts (Medicaid, Medicare, Medicare Advantage, managed care, private) tracked monthly.
- Books reconciled to your remittances, with A/R aging by payer.
- Facility payroll (nursing, therapy, dietary, housekeeping, administration).
- Cost-report-ready financials in QuickBooks Online by Certified ProAdvisors.
We track resident days and dollars, not diagnoses
Bookkeeping works from financial and census data, not the clinical chart. Your residents’ health information stays in your EHR, and we do not take it.
What we do, and what we don’t
We are a bookkeeping, payroll, and advisory firm. We do not file your CMS-2540 cost report, set your Medicaid rate, prepare tax returns, or give legal advice. Your cost-report preparer files the report; the state sets the rate from it. Income tax routes to your tax preparer. Clinical records and PHI stay in your EHR. We keep the numbers underneath all of it.
Local, secure, QuickBooks-based
Certified ProAdvisors, a secure 256-bit SSL/TLS client portal, based in Burbank and serving the LA metro.
[ Book a 20-minute cost-and-census check ]
FAQ
Does the cost report really set our Medicaid rate? In many states, yes. The state builds your per-diem from your allowable costs and resident-day counts on the cost report. Some states use other methods, so it depends on your state, but where it is cost-based, your books are what the rate is calculated from.
Do you file our cost report? No. Your cost-report preparer files the CMS-2540. We keep the books and the day counts it is built from, accurate and current.
Did the SNF cost report change? Yes. The CMS-2540-24 forms apply to cost-reporting periods ending on or after September 30, 2025 and ask for more data than before.
Do you handle our residents’ health information? No. Bookkeeping works from financial and census data only. PHI stays in your clinical systems.
Are you local? Yes. Booxmax, Inc., Burbank, CA, serving the LA metro.
This page explains general bookkeeping mechanics. It is not legal, tax, or cost-report-filing advice. The CMS-2540 is filed by your cost-report preparer and your Medicaid rate is set by the state; tax matters route to your tax preparer; clinical records stay in your EHR.
Booxmax, Inc. · 224 E Olive Ave, Ste 217, Burbank, CA 91502 · (818) 485-2669 · Info@booxmax.com · booxmax.com