Low and No Medicare Utilization Cost Report
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 (Worksheet S) along with a waiver form certifying no Medicare utilization. Prior approval from the MAC to file a no utilization cost report is not required.
Items required to be submitted for a no Medicare utilization cost report:
- Certification Page (Worksheet S), containing a valid (ink or electronic) signature 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 FQHC/RHC, $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 and CMHC is:
- Net reimbursement $200,000 or less (Medicare Part A + B)
The criteria to file a low utilization cost report for an FQHC/RHC 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 and $0 Outlier Payments
* There is no longer an option to file a low utilization cost report based on less than 10 percent Medicare utilization. This option was only available for fiscal periods ending 12/31/2016 or earlier.
Items required to be submitted for a low utilization cost report:
- Certification Page (Worksheet S), containing a valid (ink or electronic) signature by an officer or administrator.
- Applicable S-series worksheets (see below)
- 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 and Form Number | S Series Worksheets | Balance Sheet/Income Statement |
|---|---|---|
| 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 |
The Home Health Agency cost report form is the CMS 1728-20. This is a new form effective for fiscal years beginning on or after 1/1/2020 and ending 12/31/2020 or later.
- 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.
- A link to the most current form of all provider type cost reports can be found at:
- All cost reports must be filed via mail/hand delivery or MCReF (available for cost report FYE 12/31/2017 and later). Submission via NGSConnex or email is no longer available.
Questions regarding Low/No Utilization Cost Report filing:
Contact:
For information on our website:
- Select Resources then select Cost Reports
Posted 5/6/2022