Prepare a Cost Report

Taking time to prepare your Medicare Cost Report before filing can help reduce delays, minimize requests for additional information, and support a smoother review process.

This page outlines the forms, documentation, reports, and exhibits commonly needed before submitting your cost report through the Medicare Cost Report Electronic Filing (MCReF) application.

Step 1: Select the Correct Cost Report Form

Use the Medicare Cost Report form appropriate for your facility type and fiscal year end (FYE). Download the appropriate Medicare cost report forms directly from the CMS Cost Reports page.

Choosing the correct form is an important first step and helps ensure your cost report is processed accurately.

Access Cost Report Forms

Step 2: Gather Required Documentation

Core Submission Requirements

A complete cost report submission typically includes:

  • Electronic Cost Report (ECR) created using a CMS-approved vendor software solution
  • Certification Page (Worksheet S) signed by an authorized official
  • Settlement Summary on Worksheet S that matches the summary generated by the ECR
  • ECR and Print Image (PI) files with encryption codes matching those listed on Worksheet S
  • Working Trial Balance and crosswalk
  • Signed audited independent financial statements
  • Provider Statistical & Reimbursement (PS&R) report
  • Supporting documentation for:
    • Reclassifications
    • Adjustments
    • Related Organizations
    • Contracted Therapists
    • Protested Items

Additional Submission Requirements (If Applicable)

Depending on your filing method and reporting circumstances, you may also need to include:

Before You Submit

Review your documentation carefully before filing. Missing or incomplete documentation may delay processing and could result in the cost report being returned for correction.

If required elements are missing or incorrect, Noridian may return the cost report with a deficiency letter identifying the items that must be corrected. If the filing deadline has passed, interim payments may be withheld, interest and penalties may be assessed, and a demand letter may be issued. Payment suspension may remain in effect until an acceptable cost report is received.

Step 3: Prepare Electronic Exhibits

CMS provides optional electronic exhibit templates that can help improve submission accuracy and support more efficient review and processing. These templates are especially helpful when used with the Medicare Cost Report e-Filing (MCReF) system.

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.

Available Templates

  • 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)

Benefits of Using Electronic Templates

Electronic templates help streamline the cost report preparation and submission process by providing standardized formatting and a structured approach to data entry. Their built-in format reduces the likelihood of formatting issues and submission errors, helping providers submit more complete and accurate information. In addition, the consistency of electronic templates supports a more efficient review process for Medicare Administrative Contractors (MACs), which can contribute to faster processing and fewer follow-up requests.

Access Electronic Exhibit Templates

Step 4: Obtain PS&R Reports

Provider Statistical & Reimbursement (PS&R) reports are frequently used to support Medicare Cost Report preparation. Before filing, verify that you have obtained all required PS&R data and reports needed for your reporting period.

Step 5: Complete Your Certification Requirements

Before submitting your cost report, verify that all required certifications and signatures have been completed.

This may include:

  • Certification Page (Worksheet S)
  • Authorized official signatures
  • Any provider-specific certification requirements

Incomplete certifications may delay processing.

Use MCReF and e-sign via ECR software.

Preparation Checklist

Before submitting your cost report, review the items below to help avoid delays, deficiency notices, or rejection.

Cost Report Setup

Verify that you:

  • Use a CMS-approved vendor with current specifications (for electronic submissions)
  • Enter the correct PTAN, including the parent provider and all subunits
  • Use the correct fiscal year start and end dates
  • Use valid cost center codes
  • The Medicare Utilization indicator is reported correctly:
    • Blank = Full Utilization
    • N = No Utilization
    • L = Low Utilization

Required Files and Documentation

Verify that you have:

  • Submitted both the Electronic Cost Report (ECR) file and Print Image (PI) file
  • Cleared all Level 1 edits on the ECR
  • Completed and signed Worksheet S using an authorized official's signature
  • Included all required supporting documentation and attachments
  • Teaching hospitals must submit a complete and accurate Interns and Residents Information System (IRIS) file

Data and Validation Checks

Confirm that:

  • Settlement amounts on the ECR match the amounts reported on the signed Worksheet S
  • Encryption codes on Worksheet S match the encryption codes contained in the ECR and PI files. Note: Encryption codes change each time the cost report is opened or updated.

Final Review

Review all files, documentation, and validation results before submitting. Taking a few minutes to verify these items can help prevent processing delays, deficiency notices, and rejected submissions.

Need Provider Information?

Certain cost report activities may require provider identification information.

Identify or Locate a Provider

Use Noridian's provider identification resources if you need help locating:

  • Medicare Provider Numbers
  • Facility information
  • Provider identification details needed for correspondence or reporting

Identify or Locate a Provider

Ready to Submit?

Once your documentation has been gathered and reviewed, submit your Medicare Cost Report electronically through the Medicare Cost Report Electronic Filing (MCReF) application.

Go to Submit a Cost Report

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Last Updated Sep 16 , 2026