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Last Modified: 12/19/2017 Location: FL, PR, USVI Business: Part A

Low and no Medicare utilization cost reports

Per the Centers for Medicare & Medicaid Services (CMS) Provider Reimbursement Manual 2, (PRM15-2), section 110, compressed file these are conditions under which less-than a full cost report may be filed:
No Medicare utilization -- A provider that has not furnished any covered services to Medicare beneficiaries during the entire cost reporting period does not need to file a full cost report to comply with program cost reporting requirements. The provider must submit to its Medicare administrative contractor (MAC) a statement, signed by an authorized provider official, which identifies the reporting period to which the statement applies and states that:
1. No covered services were furnished during the reporting period and,
2. No claims for Medicare reimbursement will be filed for this reporting period.
This statement must be accompanied by a completed certification page of the applicable cost report forms. The proper form and signed statement must be submitted within 150 days following the close of the reporting period.
Low Medicare utilization -- The MAC may authorize less than a full cost report where a provider has had low utilization of covered services by Medicare beneficiaries in a reporting period and received correspondingly low interim reimbursement payments which, in the aggregate, appear to justify making a final settlement for that period based on less than a normally required full cost report. Based on the MAC's knowledge of the provider's Medicare utilization and interim payments in the provider statistical and reimbursement (PS&R) report and the MAC’s conclusion that it can determine the reasonable cost of covered services furnished beneficiaries, the contractor will advise the provider that less than a full cost report may be filed. Under this situation, the contractor will require that the provider furnish all of the following information using program forms:
1. Page one of the applicable cost report form,
2. The signed officer certification sheet,
3. The balance sheet,
4. The statement of income and expense, and
5. Other financial and statistical data the contractor may deem appropriate depending upon the circumstances in the individual case.
However, regardless of low Medicare utilization or the amount of aggregate interim reimbursement, the MAC may require full cost reporting and auditing if that is necessary to serve the best interest of the program. Providers must submit the forms and data under this alternate procedure within the same time period required for full cost reports. Low Medicare utilization providers may submit on a CMS approved vendor’s system the required worksheets in hard copy. ECR submission is not required and the edits are not enforceable. For example, the hospital cost report the worksheets must contain the term “In lieu of 2552-96” or "In lieu of 2552-10" on each worksheet submitted. In addition, on worksheet S the check off box for manually submitted must be properly checked. Other provider types may also submit low utilization cost reports.
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.