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May 23, 2016 - Updated 02.03.21

Medicare Cost Report (MCR) Filing Checklist Low or No Utilization Filing**

Conditions under which less than a full Medicare Cost Report may be filed

Note: Electronic cost report filing is not required for a Low Utilization or No Business cost reports. It is not appropriate to file a low utilization cost report if the provider wishes to claim reimbursement for Medicare bad debts.

  • No Business Cost Report – Provider did not provide services to any Medicare Beneficiaries
    • The signed certification page (Worksheet S) of the appropriate cost report, with an original signature from an authorized official.
    • A statement on the agency's letterhead, signed by an authorized official, identifying the provider number and cost report period. This letter must state 1) no covered services were furnished during the reporting period, and 2) no claims for Medicare reimbursement will be filed for this reporting period and be signed by an authorized official.
  • Low Utilization Cost Report – Thresholds
    • Federally Qualified Health Clinics (FQHCs): $50,000
    • Rural Health Clinics (RHCs): $50,000
    • Community Health Mental Health Clinics (CMHCs): $15,000 CMHCs with no outlier payments reported on the PS&R qualify for low utilization.
    • All Other Providers: $200,000. This includes hospital and non-hospital provider types.

Note1: Total Reimbursement is the sum of the current interim payments on the PS&R, total bi-weekly payments (including Periodic Interim Payments) and total lump sum adjustments.

Note 2: The above thresholds will be applied to the cost report being submitted for the entire provider complex (family). This means if a hospital cost report is being submitted with a provider-based FQHC, the Low Medicare Utilization threshold used will be the $200,000 hospital threshold amount; it will notbe $250,000 (which would be the hospital $200,000 threshold plus the FQHC $50,000 threshold)).

The following information is required to be submitted with a low utilization cost report:

  • Worksheet S series from the appropriate cost report with an original or electronic signature from an authorized official. See Medicare Cost Report Electronic Signatures for more information about electronic signatures.
  • Financial Reports (1) Balance sheet and (2) Statement of Income and Expense. These two reports can be from the provider's system or from the comparable worksheets from your cost report. Please note that if the provider's cost report does not have comparable worksheets for both of these reports, then you could submit a combination of your reports and cost report worksheets.
  • Teaching hospitals must submit Intern and Resident Information (IRIS) files.

**This checklist is for filing a less than full (low utilization or no business) cost report. For information regarding filing a full cost report, click here.

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