Checklist for Home Health and Hospice Cost Report Submission
The following checklist is intended to help a provider ensure all required items are submitted with a Home Health Agency (HHA) or Hospice cost report. Please ensure that the following items are included with the cost report submission:
- A CD, flash drive, or diskette containing the Electronic Cost Report (ECR) file prepared on CMS approved vendor software.
- ECR file must pass ALL Level 1 edits.
- Print Image (PI) file of the cost report on the CD, flash drive, or diskette.
- Worksheet S with encryption codes and original signature of Officer or Administrator.
- The encryption code, date, and time displayed on the certification page must match exactly with that of the ECR and PI encryption code, date and time.
- CMS Form 339 with original signature of Officer or Administrator and applicable supporting documents.
- If cost report indicates an amount is due to Medicare, a check made
payable to Medicare is mailed under separate cover to the lockbox as
follows:
CGS J15 HH and H Region B
PO Box 957124
St. Louis, MO 63195-7124 - Listing of Medicare bad debts if claimed on the cost report.
- A copy of the working trial balance to support expenses.
- Documentation to support reclassification entries, adjustment entries, and related party entries.
- Documentation to support total flu vaccine cost and charges.
Updated: 12.21.11

