Cost report reopenings
Cost report reopenings are governed by:
- 42 Code of Federal Regulations (CFR) 405.1885, 1887 & 1889
- The Provider Reimbursement Manual (PRM), Publication (Pub.) 15-1, Sections 2931-2932
Reopening instructions
In accordance with the instructions contained in 42 Code of Federal Regulations (CFR) 405.1885 and the Provider Reimbursement Manual ( PRM) 15-1, chapter 29, sections 2931 through 2932, a cost report may be reopened if a written request to reopen is received within three years from the date that the Notice of Amount of Program Reimbursement (NPR) was issued. If a Consultant submits the request, a representation letter from the provider must accompany it.
A cost report reopening may be initiated by:
- The Provider
- The MAC
- CMS
However, if fraud or similar fault is involved, First Coast can reopen the cost report at any time.
All provider initiated reopening requests must contain proper supporting documentation, as noted in PRM Pub. 15-1, Section 2931.2, and be submitted in writing to the Director of Provider Audit and Reimbursement or through the SPOT portal. Faxes and e-mail requests will not be accepted.
| Provider Type: |
Reimbursement Impact of Reopening: |
|---|---|
| Acute Hospitals, LTCHs, IPFs, IRFs |
At least $10,000 |
| CAHs, SNFs, CMHCs, ESRDs, RCHs, FQHCs |
At least $5,000 |
A complete request should include all the supporting documentation necessary to substantiate the reopening such as:
- Provider Name, Provider Number and fiscal year-end.
- NPR Date, Reopening Issue(s), Audit Adjustment Report number and applicable Work papers.
- Detailed Calculation of Reimbursement Effect: Must include the amount, supporting calculation and supporting documentation. If the provider’s request does not contain the amount, the Auditor should deny the reopening.
- Complete (for each issue) and adequate documentation to support each issue in the reopening.
- Note the regulatory reference supporting the position (if applicable).
Reopening requests must be submitted to:
Director Provider Audit and Reimbursement – JN
First Coast Service Options, Inc.
Provider Audit & Reimbursement
2020 Technology Parkway
Suite 100
Mechanicsburg, PA 17050
Clarification of what constitutes the same issue for reopenings
42 CFR 405.1885 indicates that an audited cost report can be reopened within three years of the original NPR date. Once a cost report is reopened, a provider then has three years from the date of the revised NPR to request a reopening if the request is for the same issue as the original reopening.