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Last Modified: 3/11/2021 Location: FL, PR, USVI Business: Part A

Home office cost statement (HOCS)

Form CMS-287 external pdf file was developed by CMS for the use of home offices of chain organizations in reporting the information necessary for the determination of Medicare reimbursement to components of chain organizations. This form was developed to meet the specifications for reporting and allocating costs explained previously in the Provider Reimbursement Manual, Part 2, chapter 39 external pdf file. In order to provide sufficient flexibility to meet the needs of individual home offices, alternative reporting formats may be used, subject to approval, as long as they furnish at least the applicable information contained in Form CMS-287 and fulfill the cost reporting and allocation objectives and specifications explained in chapter 31. Any alternative to Form CMS-287 must be reviewed and approved by the home office fiscal intermediary and CMS prior to its use.
When the home office operates distinct regional offices, the home office cost statement may be used to allocate home office costs to the chain components and regional offices. Home office costs allocated to the regional offices are subsequently allocated to the regional components on separate regional office home office cost statements. The regional office cost statement also allocates direct regional office costs. When separate cost statements for regional offices are prepared, a combined package including the home office and all regional office cost statements must be filed with the designated MAC. CMS approval is required for separate regional office cost statements, as outlined above.
The HOCS is not an integral part of the provider’s cost report. Therefore, it is not affected by 20 CFR 422.435(c), external pdf file which requires disclosure of providers’ cost reports. Any request received under the Freedom of Information Act (FOIA) regarding a home office cost statement is subject to a case by case determination of whether to withhold the information in whole or in part. In most cases, since the home office cost statements contain information the disclosure of which may result in a competitive disadvantage for many provider chains, the exemption from disclosure provided in 5 USC, 552(b)(4) applies.
HOCS are to be submitted within 150 days of the chain home office’s fiscal year end. If the chain home office fails to submit a cost statement within that time frame, they will be notified of their failure to submit a cost statement, and the servicing MAC will issue a demand notice requiring repayment of home office costs. The MACs are required to reduce interim payments to the providers to reflect the disallowance of any home office costs. The following forms must be completed:
The HOCS must complete a legible cost statement on the proper forms (CMS-287) in either electronic or manual format.
Provide general information and a certification page which includes the original signature of an officer (administrator, chief financial officer, or chief executive officer).
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.