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- FISS/DDE Provider Online Guide: Chapter IV - ZIP Code File (19)
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- Medicare Coverage at Rural Health Clinics for Primary Health Care Services for Medicare Patients
- Health Professional Shortage Area
- Maximum Payment Limits for Rural Health Centers
- Medicare Learning Network Articles, Medicare Monthly Review
- Prepare and Submit a Cost Report
- New York State Ambulance Services in Rural Areas
- Prepare and Submit an MSP Conditional Claim
- Telehealth Services
- Submit Supporting Documentation
Prepare and Submit a Cost Report
Table of Contents
- Prepare and Submit a Cost Report
- Submit Cost Report Documentation
- Low and No Medicare Utilization Cost Reports
- Penalties for Late Filing
- Related Content
Prepare and Submit a Cost Report
All Part A providers, with the exception of outpatient physical therapy providers and comprehensive outpatient rehabilitation facilities, are required to file an annual Medicare cost report.
- Cost reports must be submitted electronically through an approved software vendor.
- The cost report must be submitted within five months of the cost reporting fiscal year end or 60 days after a cost report reminder letter is sent to the provider by National Government Services — whichever is later.
- Filing your cost report early will provide a grace period (based on the number of days filed early) to correct any issues noted if the cost report is rejected.
- If you fail to submit a cost report timely, or if your cost report is rejected, your payments are reduced and a demand letter will be issued for previous payments.
- Providers should keep in mind that a late cost report must be reviewed for acceptance after receipt before the payment suspension is released. This could take up to 30 days from receipt of the late cost report.
- CMS maintains all cost reporting forms on their website.
- All inquiries related to PS&R reports should be directed to PSR@anthem.com.
To streamline the cost report filing process, the 2018 Inpatient Prospective Payment System Final Rule allows for an electronic signature on the cost report Worksheet S (Certification Page) for cost reports ending on or after 12/31/2017. Additionally, beginning 5/1/2018, the MCReF system is available to Part A providers for electronic transmission (e-Filing) of a cost report package directly to a MAC. A CMS IDM account is required to use MCReF, which is the same account providers use to order copies of their PS&R. The official instruction, Change Request 10611 regarding this change, is available on the CMS website. A detailed MCReF System Overview is attached to the Change Request.
The video playback from the MCReF CMS webcast on 5/1/2018 is posted on the CMS YouTube Channel.
CMS has released new Medicare cost report transmittals which support e-signature.
Starting 7/2/2018, providers that wish to e-file their cost report must use MCReF. MAC portals (NGSConnex) will no longer be an acceptable means of submission. Providers that wish to mail or hand deliver cost reports to MACs, may continue to do so.
Submit Cost Report Documentation
Providers filing an electronic cost report must include all of the items listed on the Cost Report Submission Checklist.
MCReF
MCReF is hosted on the CMS Enterprise Portal website System access to MCReF is controlled by the IDM system. Part A provider SOs and their backups (BSOs), already registered in IDM for access to CMS PS&R, will inherit access to MCReF by default through their existing account. A dedicated MCReF role within IDM is also available. The SO/BSO can also delegate this role.
Other Electronic Media Formats
- You may also send your cost report on CD or DVD (3½” diskette format or a flash drive is also permissible).
- CDs should be password protected and the password should be sent under separate cover.
- Documents submitted via MCReF must not be password protected. MCReF is a secure file transport method. Cost report files provided via MCReF that are encrypted or password protected will be rejected.
Do not send, under any circumstances, PHI by email whether or not it has been encrypted.
Electronic Filing Requirements and List of Vendors
Regulations at 42 CFR 413.24 (f)(4) outlines the requirements of electronic submission of cost reports, which are further defined in the policy of the CMS IOM Publication 15-2, Provider Reimbursement Manual, Section 130ff. When filing the cost report, you must use approved vendor software unless specifically authorized to file a less than full cost report as specified in CMS Publication 15-2, Provider Reimbursement Manual, Section 110 or have been granted prior written waiver under Section 130.3.
Approved XML IRIS Vendors
Below is a list of software vendors who have submitted sample XML IRIS files to CMS that have been confirmed to meet the requirements of the new XML IRIS file format. Providers are not required to use vendors from this list.
- Besler - iRotations
- Health Financial Systems – HFSSoft IRIS
- MyEvaluations.com - MyGME
- New Innovations
Home Office Cost Statements
- Include a completed and legible cost statement on the proper forms (CMS-287-22).
- Provide general information and certification page which includes the original or electronic signature of an officer (administrator, chief financial officer, or chief executive officer).
If you file via MCReF, Home Office Cost Statement CMS Form 287-22 now supports e-signature. There is no longer a requirement to upload a scanned copy of the certification page via the “Signed Certification Page” slot, and mail/hand-deliver a hard copy with a signature signed in ink to your MAC.
Home office cost statements are to be submitted within 150 days of the chain home office’s fiscal year end. If the chain home office fails to submit a cost statement within that time frame, they will be notified of their failure to submit a cost statement, and the servicing intermediary will issue a demand notice requiring repayment of home office costs. The MACs are required to reduce interim payments to the providers to reflect the disallowance of any home office costs.
Low and No Medicare Utilization Cost Reports
No Utilization Cost Reports
To comply with program cost reporting requirements, a provider that has not furnished any covered Medicare services during a cost reporting period must only complete the certification page of the cost report along with a waiver certifying no Medicare utilization.
Items required to be submitted for a no Medicare utilization cost report:
- Certification Page (Worksheet S), containing a valid signature (ink or electronic) by an officer or administrator.
- Signed Low/No Utilization Cost Report Waiver form
Low Utilization Cost Reports
If a provider has been reimbursed $200,000 or less ($50,000 for RHC or FQHC or $15,000 for CMHC) during the cost report period, they may qualify to file a low utilization cost report and waive filing of the ECR disk. Prior approval from the MAC to file a low utilization cost report is not required.
The qualifying criteria to file a low utilization cost report for a provider type other than FQHC/RHC or CMHC is:
- Net reimbursement $200,000 or less (Medicare Part A + B)
The criteria to file a low utilization cost report for an RHC or FQHC is:
- Net reimbursement $50,000 or less
The criteria to file a low utilization cost report for a CMHC is:
- Net reimbursement $15,000 or less
- $0 outlier payments reported on the PS&R
Items required to be submitted for a low utilization cost report:
- Certification Page (Worksheet S), containing a valid signature (ink or electronic) by an officer or administrator.
- Applicable S-series worksheets (see below). For FYE 12/31/2017 and later, electronic signature and/or submission via MCReF is acceptable in lieu of mailing original signature.
- Balance sheet and income statement (these can be worksheets from the cost report, ex. F-series worksheets – see below)
- Signed Low/No Utilization Cost Report Waiver form
| Cost Report Type | S Series Worksheets | Balance Sheet/Income Stmt |
|---|---|---|
| SNF 2540-10 | Worksheet S, S-3 Pt I | G and G-3 |
| Hospital 2552-10 | Worksheet S, S-3 Pt I | G, G-2 and G-3 |
| HHA 1728-20 | Worksheet S, S-3 Pt I | F and F-1 |
| Hospice 1984-14 | Worksheet S, S-1 Pt II | F and F-2 |
| RHC 222-17 | Worksheet S, S-1 Pt I Lines 1-14 | Balance sheet and income statement are required |
| FQHC 224-14 | Worksheet S, S-1 Pt I Lines 1-14 | F-1; balance sheet is required |
| ESRD 265-11 | Worksheet S | F and F-1 |
| CMHC 2088-17 | Worksheet S, S-1 Pt I Lines 1-14 | F; balance sheet is required |
By filing a no/low utilization MCR, the provider accepts interim payments as final settlement. The MAC reserves the right to require a full cost report if after review it deems it necessary to best serve the interest of the Program.
Questions regarding Low/No Utilization Cost Report filing, email:
JK_Cost_Report_Filing@anthem.com
or
J6_Cost_Report_Filing@anthem.com
Penalties for Late Filing
In the event that you fail to timely file an acceptable cost report with all required information, such as the print image file generated using a current version of CMS-approved ECR vendor software, Medicare payments will be suspended until a cost report is filed and determined to be acceptable (see 42 CFR Section 405.371 [C]). All interim payments paid for the period are considered overpayments.
If your cost report indicates an overpayment, the amount due should be mailed to the appropriate lock box with a copy of the check sent along with the cost report. If this is not possible because of a financial hardship, please submit a repayment proposal and supporting financial data. If full payment or an extended repayment plan is not submitted with the cost report, interim payments will be suspended upon receipt of the cost report. If no payment arrangements are made as indicated above, the NGS Part A Overpayment Recovery Department will send you a demand letter requesting payment of the amount due. The demand letter will indicate that interest will begin accruing from the day after the cost report is due and is calculated in 30-day increments for each full 30-day period until the cost report is filed and accepted. In addition, failure to file a cost report will result in a referral to the Department of Justice for collection, as well as possible termination from the Medicare Program.
If the cost report is rejected, it is deemed unacceptable and treated as if it were never filed. Specifically, as is mentioned above, if an acceptable cost report is not submitted timely, a suspension of payments will be imposed. Accordingly, when a cost report is filed timely, but is rejected, and thereby deemed unacceptable, a suspension of payments will be implemented under the provisions of 42 CFR Section 405.371 (C). In addition, in this situation, and in the situation where a cost report is not filed timely, interim payments for the period will be considered overpayments until an acceptable cost report is filed.
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Revised 4/16/2024