File an Amended Cost Report

A provider may elect to submit an amended cost report subsequent to the initial filing. The CMS Medicare Paper-Based Manuals Publication 15-1, Provider Reimbursement Manual—Part I, Chapter 29 Section 2931.2A, allows the Medicare Administrative Contractor to accept an amended cost report under limited circumstances.

To file an amended cost report:

1. Submit a cover letter that indicates the specific reason(s) for the amended submission (what is changing and the reason for the change).
2. With each issue, provide as much supporting documentation as necessary to justify each change as well as the Medicare reimbursement effect on each issue.
3. If you are amending a hospital, SNF, HHA, ESRD, CMHC, FQHC or hospice cost report, you must submit new electronic cost report files (EC and PI files) along with a signed and encrypted Worksheet S/signature page. Amended cost reports can be submitted via mail or e-filing via MCReF (MCReF is available for FYE 12/31/2017 and later).

Once the amended cost report is received in our office, we will review it for acceptability and determine if it is a valid and acceptable amended report. If we deny a portion of your request, you can decide to refile for the issues not in dispute

Timeframe to Amend the Medicare Cost Report

An amended cost report may be submitted prior to the initial Notice of Program Reimbursement (i.e. Prior to final settlement). If the cost report is scheduled for a desk review, it must also be received prior to the initiation of the desk review. The desk review is the beginning stage in which a Medicare auditor starts to analyze the data submitted in/with the cost report. Therefore, it is important that all cost report changes be received prior to the start of the desk review.

NGS has had a long-standing practice of sending an initial letter in advance of starting the desk review for select hospital cost reports as a courtesy. Going forward, in lieu of these letters, providers may contact NGS to obtain the status of cost reports and the projected start of the desk review by sending an inquiry. For Jurisdiction K providers, inquiries can be sent to JKLeadsMailbox@anthem.com. For Jurisdiction 6 provider, inquiries can be sent to J6Leads@anthem.com.

There are a few defined exceptions to the timing of filing amended data as noted below:

• CMS Issues case specific instructions

  Example 1: IPPS hospital cost report revisions for wage index. Current CMS instructions permit revisions to be submitted to the MAC outside of an amended cost report submission.

  Example 2: Federal Register dated 11/13/2015 states that contractors must accept one amended cost report if submitted within a 12-month period after the hospital’s cost report due date, solely for the specific purpose of revising a claim for DSH by using updated Medicaid-eligible patient days, after a hospital receives updated Medicaid eligibility information from the state. If submitting such an amended cost report, the hospital must include:

1. The number of additional Medicaid-eligible patient days that the hospital is seeking to include in the DSH calculation;
2. A description of the process that the hospital used to identify and accumulate the Medicaid-eligible patient days that were reported and filed in the hospital’s Medicare cost report at issue; and
3. An explanation of why the additional Medicaid-eligible patient days at issue could not be verified by the state by the time the hospital’s cost report was submitted.

• If the cost report was selected for a worksheet S-10 DSH UCP audit, the amended data must be submitted prior to the start of the audit.

We encourage being proactive in determining the need to submit an amended cost report. We recommend contacting NGS to obtain the cost report status early in the process as changes in workload scheduling do occur over time.

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Reviewed 5/9/2024