Low and no Medicare utilization

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Home ► PARD cost reports ► Low and no Medicare utilization

Last Modified: 3/19/2024 Location: FL, PR, USVI Business: Part A

Low and no Medicare utilization cost reports

Per the 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 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.

Effective for all cost reports received on or after June 19, 2020, the MACs are instructed to use the following defined “Low Medicare Utilization Thresholds” compared to total reimbursement amounts to determine whether a provider qualifies to file a low utilization cost report in accordance with PRM 15-2, Section 110:

• Federally Qualified Health Clinics (FQHCs): $50,000

• Rural Health Clinics (RHCs): $50,000

• All Other Providers: $200,000. This includes hospital and non-hospital provider types

• Community Mental Health Clinics (CMHCs): $15,000 CMHCs with no outlier payments reported on the PS&R qualify for low utilization.

• Note 1: 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 not be $250,000 (which would be the hospital $200,000 threshold plus the FQHC $50,000 threshold))

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, *unless opting to electronically sign (*See below)

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 encourages all providers to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more efficient from a time and cost perspective.

We now offer the choice of filing your cost report via the MCReF (Medicare Cost Report e-Filing) portal. The new MCReF portal is a streamlined feature that allows your facility to submit your cost report same day electronically without the cost of sending any hard copy documents! The MCReF system is a secure site that allows for a safe and instant submission of protected health information (PHI). MCReF also notifies you instantly of any submission issues and also stores all your files, resulting in less rejection issues. Sign up today and save time and money!

Information on registering and filing can be found on the MCReF homepage at: mcref.cms.gov external link

For the latest updates regarding MCReF as well as IDM registration information, the MCReF User Manual and FAQS please visit:

https://www.cms.gov/Medicare/Compliance-and-Audits/Part-A-Cost-Report-Audit-and-Reimbursement/MCReF external link

Here you can also register for any upcoming training webinars as well.

While using MCReF, please refer issues or questions to:

Phone: 866-484-8049, 866-523-4759 TTY/TDD

Email: eussupport@cgi.com

Website: https://eus.custhelp.com/app/answers/list external link

Note: When using MCReF to e-file your submission you can also now elect to sign electronically, saving time! (*See Below)

Protected health information (PHI) uploaded via MCReF (Medicare Cost Report e-Filing) portal cannot be encrypted or password protected and will result in a rejection of your submission. The MCReF portal is a safe secure cost report submission option and does not require encryption.

*Please note, effective for cost reporting periods ending on or after December 31, 2017, a provider that is required to file an electronic cost report may elect to electronically submit the settlement summary and certification statement with an electronic signature of the provider's administrator or chief financial officer. The checkbox for electronic signature and submission immediately follows the certification statement and must be checked if electronic signature and submission is elected.

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