The electronic cost report must be created on CMS-approved cost report software. Submit the electronic cost report, along with supporting documentation, on a CD-ROM (preferred), diskette, or flash drive. When submitting protected health information (PHI), proper steps must be taken to ensure it is encrypted and complies with Federal Information Processing Standards (FIPS) 140-02. First Coast offers the option of filing your cost report via the MCReF (Medicare Cost Report eFiling) portal. Information on registering and filing can be found on the MCReF homepage. Please note that the originally signed Worksheet S certification page must be submitted in hardcopy format per CMS regulations or 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 must be checked if electronic signature and submission is elected.