Top Provider Questions – Cost Report
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- My June 30th cost report is due November 30th. When will I receive my Provider Statistical and Reimbursement (PS&R) data?
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The Centers for Medicare & Medicaid Services (CMS) redesigned the PS&R with a new system that is now operational. The redesigned PS&R system will be utilized for all cost reports with fiscal years ending January 31, 2009, and later. The new PS&R system allows providers to obtain their own PS&R reports that are needed to file the cost report. The Medicare Administrative Contractor (MAC) is no longer required to send providers their PS&R reports, unless the provider cannot access the system and informs the MAC of the issue. Please see the Provider Statistical and Reimbursement Reports Web page for further explanation of the new PS&R system.
Reviewed 12/20/2022
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- What are the requirements for filing a no or low utilization cost report?
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Providers not furnishing any covered Medicare services during a cost reporting period are eligible to file a "No Utilization" cost report, which is a signed Worksheet S and a No Utilization letter. In these cases, the provider must submit a completed worksheet S of the applicable cost report form with an original or electronically certified signature of an authorized official. A signed statement identifying the provider number and cost reporting period also must be submitted. This statement must indicate that no covered services were furnished and no claims for Medicare reimbursement will be filed for the cost reporting period.
Providers furnishing covered Medicare services for which they have or will receive $200,000 or less in total net reimbursement for the year are eligible to file a "Low Utilization" cost report. If you file your cost report as a low utilization, you may not subsequently file a full cost report and the amount received for the fiscal period will be considered your final settlement. Providers filing a low utilization HHA cost report complete Worksheet S, Parts I & II, S-2, S-3, Parts I-IV, S-5 (if applicable), F, F-1 and F-2 of the form 1728-20. Low utilization Hospices complete Worksheet S, Parts I & II, S-1, F, F-1, and F-2 of the Form 1984-14.
Low/No Medicare utilization providers may submit the required worksheets on a CMS approved vendor system or in hard copy. Electronic Cost Report (ECR) submission is not required and the edits are not enforceable. The CMS 339 Questionnaire does not need to be completed for low utilization cost reports. Also needed to be submitted with the low utilization cost reports are:
- The officer's signature on the certification statement
- The balance sheet
- Statement of income and expense
- Other financial and statistical data the contractor may deem appropriate.
Effective for cost reports due on or after February 1, 2016, providers with greater than $30,000 in Medicare vaccine charges will need to file a full cost report. No or low utilization Medicare cost reports with greater than $30,000 in Medicare vaccine charges will be rejected and may result in a withholding of payments.
Please review the information on the No or Low Utilization Cost Reports Web page. If, after reviewing this information, you still have questions, please contact us.
Reviewed 12/20/2022
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- I received my letter informing me when my cost report is due, but my forms were not with it. Where can I get them?
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The cost reporting forms can be found on the CMS website, Chapter47 (Form 1728.20) for HHAs and Chapter 43 (Form 1984-14) for Hospices. Open the appropriate zip file for your provider type to access the cost report forms.
Reviewed 12/20/2022
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- The bottom line of my cost report shows a minimal amount due back to Medicare. Do I still need to submit a check with my cost report submission?
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With a Prospective Payment System (PPS) in place, the settlement amount on the home health cost report should be zero unless there is cost reimbursed activity during that fiscal year end. If a settlement occurs, it is most likely due to rounding. For settlements with less than $5 due to program, CGS will not be requesting a settlement until the cost report has been audited. Therefore, if the cost report shows that less than $5 is due to the Medicare program, no check will need to be submitted with the cost report.
Reviewed 12/20/2022
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- Who do I contact for additional questions regarding cost report receipts or tentative settlements?
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Please contact us if you have question regarding cost report submission.
Reviewed 12/20/2022
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- Are there any tips you can provide for home health agencies completing the Medicare Cost Report (MCR)?
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- File your cost report early. Filing early could help avoid penalty holds on Medicare reimbursement.
- Worksheet S-3 Part 1 Column 10 is not a calculated field. The total patients must be entered manually.
- On Worksheet F, Total Assets must equal Total Liabilities plus Total Fund Balances. (County HHAs are not required to complete the F series.)
- HHAs are no longer required to complete Worksheets A-1, A-2, A-3, and A-8-3.
- If submitting a full cost report, all level one edit errors must be resolved before submission or the cost report may be rejected.
Reviewed 12/20/2022
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- I submitted my cost report late. How much longer until we are off penalty withhold?
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The CGS Provider Audit department has 30 days from the date of receipt of the costs report to determine the acceptability of the cost report. Upon determination of acceptability Provider Audit will notify the CGS Administrators Banking team to remove the penalty withholding and release any funds withheld.
Reviewed 12/20/2022
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- I verified with Provider Audit that my cost report was accepted. How much longer until we are off a penalty withhold?
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Once the CGS Administrators Banking team is notified that your cost report has been accepted, the penalty withhold is lifted within 24 hours. However, it may take 48 hours for the system to cycle before the funds are dispersed. Please note Electronic Funds Transfer (EFT) transactions take 48 hours to be deposited into your account. Also note that while the cost report hold may be released, if there are other payment holds, for your facility, funds will not be dispersed.
Reviewed 12/20/2022
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- My facility has closed; do I still need to send in a cost report?
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Yes. Providers are required to submit a cost report every year, even if the provider has no utilization. For example, if the facility closed on March 31, 2015, and the fiscal year end was December 31, 2015; the provider is required to submit a cost report for the period of January 1, 2015, through March 31, 2015, even if there was no utilization for those three months.
Reviewed 12/20/2022
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- I have a new facility; when do I send in my cost report?
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The cost report should not be sent until the provider receives a letter from CGS, telling them when the cost report is due. CGS cannot accept a cost report before the Tie-In (Notice of Medicare Service with the new provider number) is received from CMS. If the provider submits the cost report before CGS has received the Tie-In from CMS, it will be rejected and returned.
Reviewed 12/20/2022
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- Where do I send my cost report for Home Health and Hospice providers serviced by CGS?
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Regular Mail (USPS):
CGS Administrators
J15 HHH Audit/Reimbursement
PO Box 20015
Nashville, TN 37202Courier Service (FedEx/UPS):
CGS Administrators
J15 HHH Audit/Reimbursement
26 Century Blvd STE ST610
Reference: 20015
Nashville, TN 37214Reviewed 12/20/2022
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