Audit and Reimbursement

Cost Report Due Date

The due date calculator determines the date a cost report must be received by Noridian in order to meet CMS requirements.

A cost report must be received by Noridian 5 months after a facility’s FYE. If a cost report is not received by that date, payments will be suspended and a demand letter will be issued.
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Cost Reports

Access the below related information from this webpage

Medicare Cost Report Overview

All Medicare Part A providers, except for outpatient physical therapy providers and comprehensive outpatient rehabilitation facilities, are required to submit an annual Medicare cost report (MCR).

The cost report helps determine whether a facility has been underpaid or overpaid by Medicare. It includes detailed financial and operational data that is submitted to the Centers for Medicare & Medicaid Services (CMS).

CMS stores this information in the Healthcare Provider Cost Reporting Information System (HCRIS). The data typically includes:

  • Facility characteristics
  • Utilization statistics
  • Costs and charges by cost center (both total and Medicare-specific)
  • Medicare settlement details
  • Financial statement summaries

Cost Report Due Date

Cost reports are due on or before the last day of the fifth month following the end of the provider's fiscal year. A cost report is considered timely if it is postmarked by the due date, regardless of whether it is submitted as a hard copy or on a diskette. If the due date falls on a Saturday, Sunday, or federal holiday, the report is considered timely if it is postmarked on the next business day.

In the case of a Medicare Provider Agreement or Change in Ownership Termination, cost reports are due no later than five months following the effective date of the provider agreement or the change of ownership termination. Items two through 4 in subsection A of the Provider Reimbursement Manual (PRM), 15-2, Chapter 1, Section 104 will apply.

Cost Report Extension Requests

Medicare cost report extensions are only granted under extraordinary circumstances that significantly disrupt a provider's operations and are beyond the provider's control (e.g., natural disasters such as floods or fires). In these cases, Noridian must obtain CMS approval before an extension can be granted.

To request an extension, providers should complete the Cost Report Extension Request Form, available on our Audit and Reimbursement Forms page. The completed form should be emailed to: costreportextension@noridian.com

Important: We must obtain a signature by an Authorized Official or Administrator listed in the provider's Medicare enrollment record or currently listed in the System for Tracking Audit and Reimbursement (STAR).

Cost Report Forms

Download the appropriate Medicare cost report forms directly from the CMS Cost Reports page. Be sure to select the correct form based on your facility type and fiscal year end (FYE) to ensure compliance and avoid delays.

Electronic Exhibit Templates

To support a more efficient Medicare Cost Report (MCR) process, CMS provides optional electronic templates for key exhibits. These templates are especially helpful when used with the Medicare Cost Report e-Filing (MCReF) system.

Why Use Electronic Templates?
  • Faster processing and fewer rejections or amendments
  • Built-in formatting to guide accurate data entry (e.g., date fields, dropdown menus)
  • Automatic feedback from MCReF on potential issues
  • Standardized layout for easier review by Medicare Administrative Contractors (MACs)
Template Features

Each template:

  • Follows CMS specifications for layout and field requirements
  • Includes labeled fields, formatting rules, and data entry guidance
  • Available in .xlsx or .xlsm format for easy submission
Available Templates

Templates are available for the following exhibits:

  • Medicare Bad Debt Listing (multiple versions based on MCR type)
  • Medicaid Eligible Days (Exhibit 3A)
  • Charity Care Charges (Exhibit 3B)
  • Total Bad Debt (Exhibit 3C)

All templates are pre-formatted and ready for use. You can find them under the Downloads section at the bottom of the CMS Electronic Cost Report Exhibit Templates page.

Low/No Medicare Utilization

No Medicare Utilization

Providers that did not furnish any covered services to Medicare beneficiaries during the entire cost reporting period are not required to file a full cost report. Instead, they must submit:

  • A signed statement from an authorized official that:
    1. Identifies the applicable reporting period
    2. Confirms that no covered services were provided
    3. States that no Medicare claims will be submitted for that period
  • A completed certification page from the applicable cost report form

This documentation must be submitted to Noridian within 150 days after the end of the reporting period.

Low Medicare Utilization

Providers with low Medicare utilization and low interim reimbursement payments may qualify to file a reduced cost report. This option is available when the total Medicare reimbursement falls below the following thresholds:

Provider Type Reimbursement Threshold
Hospital $200,000
Skilled Nursing Facility (SNF) $200,000
Rural Health Clinic (RHC)/Federally Qualified Health Clinic (FQHC) $50,000

Notes:

  • Total reimbursement includes interim payments (from Provider Statistical & Reimbursement (PS&R) System)), bi-weekly payments (including Periodic Interim Payments (PIP)),and lump sum adjustments.
  • Thresholds apply to the entire provider complex. For example, a hospital with a provider-based FQHC must meet the $200,000 hospital threshold, not a combined $250,000.
  • Providers with short-period cost reports must annualize their reimbursement to determine eligibility.
  • Providers filing under low utilization cannot claim Medicare bad debts. If bad debts are being claimed, a full cost report is required.
Required Forms for Low Utilization Reports

All submissions must include:

  • Signed Officer Certification Sheet with applicable Worksheet S pages
  • Balance Sheet
  • Income and Expense Statement (Worksheet G series may be used)

Additional worksheets vary by provider type:

Hospitals (Form CMS 2552-10):

  • Worksheet S-2
  • Worksheet S-3
  • Worksheet E Series

Skilled Nursing Facilities (Form CMS 2540-10):

  • Worksheet S-3
  • Worksheet E Series

FQHCs and RHCs (Forms CMS-224-14 and 222-17):

  • Worksheet S, Parts I-III
  • Worksheet C, Parts I-II

Important Reminders

  • Low/No utilization reports must be submitted within the same timeframe as full cost reports.
  • If Noridian later determines that the criteria were not met, or that a full report is needed in the best interest of the program, a full cost report will be required.

Cost Report Required Elements

To ensure your Medicare cost report is accepted and processed without delay, include the following required components:

Core Submission Requirements

  • Electronic Cost Report (ECR) on a readable disk, created using a CMS-approved vendor or submitted via MCReF (if filing electronically)
  • Certification Page (Worksheet S) with the original signature of an authorized official
  • Settlement Summary on Worksheet S must match the summary generated by the ECR
  • Check payable to Noridian, if the cost report indicates an amount due to Medicare
  • ECR and Print Image (PI) files with encryption codes matching those listed on Worksheet S
  • Working Trial Balance and crosswalk
  • .MCP file through Health Financial System (HFS) preferred
  • Signed Audited Independent Financial Statements
  • Supporting documentation for:
    • Reclassifications
    • Adjustments
    • Related Organizations
    • Contracted Therapists
    • Protested Items
  • Provider Statistical & Reimbursement (PS&R) Report

If applicable

If any required elements are missing or incorrect, Noridian will return the cost report with a letter explaining the deficiencies. If the due date has passed, interim payments may be withheld, interest and penalties assessed, and a demand letter issued, typically within 30 days. Payment suspension will remain in effect until an acceptable cost report is received.

Pre-Submission Checklist

Before submitting, verify the following to avoid rejection:

  • Used a CMS-approved vendor with current specifications (if electronically)
  • Enter the correct PTAN, including parent and all subunits
  • Use the correct fiscal year start and end dates
  • Submit both the ECR file and PI file
  • Clear all Level 1 edits on the ECR
  • Ensure Worksheet S is signed by an authorized official
  • Confirm encryption codes on Worksheet S match those in the ECR and PI files
    • Note: Encryption codes change each time the cost report is accessed or updated
  • Teaching hospitals must submit a complete and accurate IRIS disk
  • Verify settlement amounts on the ECR match those on the signed Worksheet S
  • Answer the Medicare Utilization question correctly:
    • Blank = Full Utilization
    • N = No Utilization
    • L = Low Utilization
  • Use valid cost center codes

How to Submit Your Cost Report

Electronic Submission Options

We strongly encourage you to submit your cost report electronically rather than by mail. Electronic submission offers several advantages:

  • Cost savings on postage
  • Reduced risk of lost or delayed mail
  • Access to CMS Electronic Exhibit Templates for streamlined reporting
  • Centralized and organized recordkeeping
  • Simplified revisions and resubmissions
  • Environmentally friendly - reduces paper use and waste

There are two approved methods for electronic submission:

Mail Submission Instructions

If you are submitting your cost report by mail, follow the guidelines below to ensure timely and efficient processing:

Required Materials
  • A signed Worksheet S (on paper)
  • A check, if applicable (on paper)
  • All other documentation may be submitted on a disk or USB drive
Mailing Guidelines

To avoid delays:

  • Submit only one cost report per envelope
  • Mail all required items together
  • Do not staple, paperclip, or bind any pages
  • Complete the Provider Audit Media Submission Form (available on our Audit and Reimbursement Forms page) and email it to: nhspass@noridian.com
    • Include in the email
      • The password for any password-protected media
      • The PTAN and fiscal year end (FYE) in the subject line
      • Any tracking information in the body of the email (if applicable)
Mailing Address

Please refer to our Mailing Addresses page for the appropriate PO Box or courier delivery address.

Important Postmark Information: Noridian only accepts postmarks placed by the United States Postal Service (USPS) as valid.

  • A metered postage machine postmark is not considered valid unless it is accompanied by a USPS postmark.
  • If a USPS postmark is not present, the receipt date will be used as the official postmark date.

Cost Report Processing Timelines

To ensure transparency and predictability in the cost report lifecycle, refer to the following processing benchmarks:

  • Acceptance or Rejection:
    Cost reports will be reviewed for completeness and accepted or rejected within 30 days of the date of receipt or postmark date.
  • Tentative Settlement (TS):
    A tentative settlement will be issued within 90 days of the cost report acceptance date.
    • Exceptions: No TS will be issued for providers in an active bankruptcy, terminated providers or providers in process of a change of ownership (CHOW).
  • Midyear Lump Sum Adjustment (if applicable):
    In addition to the tentative settlement, a midyear lump sum adjustment may be processed to ensure payments accurately reflect current rates.
  • Modified Desk Review (MDR):
    A modified desk review will be completed within 90 days of the cost report acceptance date. If eligible for the MDR process rather than the limited or full desk review or audit, the NPR packet will be issued within this same timeframe.
    • Exceptions: Providers in process of a change of ownership and eligible for MDR process will receive their NPR packet once the CHOW has been finalized.
  • Finalization Without Audit:
    Cost reports will be finally settled in accordance with the timelines outlined in the CMS Internet-Only Manual (IOM), Publication 100-06, Medicare Financial Management, Chapter 8, Section 90, unless alternative instructions are provided by CMS (e.g., via a Change Request or Technical Direction Letter).
  • Finalization With Audit:
    If selected for a limited or full review with an audit, finalization will occur within 60 days following the final exit conference.
  • Year-End and Lump Sum Review:
    Within 90 days prior to the end of the next fiscal year, a year-end review and lump sum review may be conducted.

How to Obtain a Copy of a Cost Report

Medicare cost report data is collected by CMS and made publicly available through the Healthcare Cost Reporting Information System (HCRIS). These reports can be accessed on the CMS Cost Reports webpage.

Requesting a Cost Report via FOIA

Cost reports are also available through the Freedom of Information Act (FOIA). To request a Medicare cost report, please include the following details in your request:

  • Facility Name
  • Medicare Provider Number (if known; if unknown, include the state in which the facility operates)
  • Fiscal Year-End of the cost report being requested
  • Specify whether you are requesting the:
    • As-Filed Cost Report, or
    • Finalized Cost Report (if available)
    • Optionally, indicate if you are requesting specific worksheets only

Submitting a FOIA Request

FOIA requests for cost reports or other provider audit and reimbursement records can be submitted using the Freedom of Information Act Request Form.

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