Submit Supporting Documentation

We encourage you to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more time and cost efficient.

The following documents should be sent in an electronic format (via MCReF or on CD-ROM, flash drive, floppy disk, etc.):

• The ECR and PI files utilizing the CMS-approved vendor with current specification date. ECR passes all level I edits*
• If you are claiming costs for interns and residents, IRIS data files that pass all IRIS edits in the CMS IRISEDV3 software*
• Working Trial Balance and crosswalk
• Signed Audited Independent Financial Statements
• Bad debt listing*: If you claim Medicare bad debts your submitted listings must match the amount claimed on the cost report. Fee-based bad debts should not be included in this listing. Providers should utilize Exhibit 2. It is also requested that Exhibit 2 be completed in Excel. Please ensure all columns are correctly completed. Refer to the Checklist for Reviewing Your Bad Debt Listing.
• Wage index documentation (acute hospitals only)
• Documentation for any reclassifications, adjustments, related organizations, contracted therapists and protested items
• DSH Listing* ‒ for hospitals claiming DSH payment adjustment, a detailed listing of the hospital’s Medicaid-eligible days that corresponds to the Medicaid-eligible days claimed in the cost report.
• Charity Care & Uninsured Discounts* ‒ for DSH-eligible hospitals reporting charity care and/or uninsured discounts, a detailed listing of charity care and/or uninsured discounts that correspond to the amounts claimed in the cost report.  The list must include information such as patient name, dates of service, insurer (if applicable), and amount of charity care and/or uninsured discount given to patient.
• Home Office Cost Allocations* ‒ for providers claiming costs allocated from a home office or chain organization, the cost report may be rejected if the home office has not submitted a Home Office Cost Statement to the chain provider’s servicing contractor (MAC).
• Signed and completed Attestation Form, Children’s Hospitals Verification of Age for Eligibility (Children’s hospitals only—form with instructions are located on the Cost Report Filing Requirements page of the National Government Services website [use search keywords: cost report filing])

*These items are required to meet CMS Cost Report Acceptance standards. If any of these items are not included, the cost report may be rejected.

PHI or PII sent on electronic media must be password protected or encrypted to avoid unintended access via CMS-approved software, i.e., SecureZip. For security purposes, the password must be sent separately.

If you are filing an electronic cost report, you must include all of the items listed on the Cost Report Submission Checklist.

To streamline the cost report filing process, the 2018 IPPS 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 EIDM 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.

Related Content

• IRIS ‒ Access to CMS IRISV3 and IRISEDV3 software and information

Please share your thoughts about your experience with our Audit and Reimbursement process. 

Revised 4/16/2024