Completing an Abbreviated Cost Analysis Toolkit
Welcome to the Toolkit
Cost analysis is a process that allows Title X grantees and subrecipients to determine the true cost of the services they provide to family planning clients. As expenses and utilization will vary from year to year, performing a cost analysis annually is recommended. A cost analysis helps Title X grantees and subrecipients to:
- Inform full fee establishment/updating process for each service provided by a Title X-funded project
- Determine if the cost of services is on par with Medicare and third-party payer reimbursement rates
- Measure clinical services provider productivity
- Demonstrate compliance with Title X Program Expectations, which state, “For persons from families whose income exceeds 250% of the FPL, charges must be made in accordance with a schedule of fees designed to recover the reasonable cost of providing services. (42 CFR 59.5(a)(8)).”
This toolkit outlines the Abbreviated Cost Analysis, a streamlined approach based on a simple expense worksheet that does not include labs due to their low costs and relative value units (RVU).
The toolkit is organized sequentially into three sections:
- Planning for a Cost Analysis
- Conducting a Cost Analysis
- Using Cost Analysis Data
The resources can be used in any order according to an agency’s needs and priorities.
Title X grantees and subrecipients conduct cost analyses differently. Grantees may require a certain cost analysis format and the frequency of when/how often it is completed. Further, they may:
- Conduct a cost analysis for all service sites over which they have financial control
- Provide subrecipients with an Abbreviated Cost Analysis workbook, pre-loaded with network specific data (e.g., Medicaid and Medicare rates, RVUs per current procedural terminology (CPT))
- Allow subrecipients to complete their own version of a cost analysis and report data to the grantee
Grantees should support subrecipients by interpreting cost analysis data and/or providing guidance regarding how the data can be used/interpreted. If a grantee plans to provide analysis based on the network’s results to allow for accurate comparisons and network averages, all sites in a network should utilize the same cost analysis method.
Grantee and subrecipient staff who will be involved in the cost analysis should have a shared understanding of the terms, timeline, data elements, and methodology being used. Collecting all cost and utilization data prior to completing the Abbreviated Cost Analysis Workbook may save time.
| Action Steps | Supportive Resources |
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Orient all grantee and subrecipient staff who will conduct a cost analysis. |
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Gather family planning cost (staff and project) data from accounting software. |
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Gather utilization data (CPT codes and volume) from electronic health record. |
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Gather the following information:
Note: Information can be gathered as time permits and as available. All information does not need to be gathered at the same time.
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There are four tabs in the Abbreviated Cost Analysis workbook:
- COST CALCULATION: expense, or “cost” data required
- UTILIZATION: utilization data required
- RVUs: pre-populated with CMS RVU values for commonly used CPT codes
- GPCIs: pre-populated with GPCI values that allow for location-specific analysis
| Action Steps | Supportive Resources |
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Input cost data into the Cost Calculation tab of Abbreviated Cost Analysis Workbook. |
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Input utilization data (CPT codes and volume) for medical services provided into the Utilization tab of the Abbreviated Cost Analysis Workbook. |
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As needed, input updated in the Abbreviated Cost Analysis Workbook:
Note: Information can be input as time permits and does not need to be done at the same time. |
A Title X grantee and/or subrecipient may take any of the actions listed below once a cost analysis is completed.
| Action Steps | Supportive Resources |
|---|---|
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Document pertinent CPT reimbursement rates and charges, and interpret cost analysis results. |
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Inform full fee establishment/updating process for each service provided. |
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Develop or revise sliding fee discount schedule based on new full fee schedule. |
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Measure clinical services provider productivity. |
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Provide analysis and/or technical assistance to subrecipients. |
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Conduct project management.
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