Understand Cost Report Requirements - JE Part A
Understand Cost Report Requirements
Most Medicare Part A providers are required to submit an annual Medicare Cost Report. Cost reports provide financial and statistical information used to reconcile Medicare reimbursement and support program administration.
Understanding your reporting obligations, filing deadlines, and the review process can help you avoid delays and ensure a smoother filing experience.
What Is a Medicare Cost Report?
A Medicare Cost Report is an annual filing submitted to CMS that reports financial, statistical, and operational information about your organization.
The information reported is used to:
- Determine whether a provider has been underpaid or overpaid by Medicare
- Support Medicare reimbursement and settlement activities
- Analyze utilization and financial trends
- Support audit and program integrity activities
Who Must File?
Most Medicare Part A providers are required to submit a Medicare Cost Report each year.
Reporting requirements vary by provider type and circumstances. Providers should ensure they are using the correct cost report form and reporting period for their submission.
What Information Is Included?
A Medicare Cost Report may include:
- Facility characteristics
- Utilization statistics
- Total and Medicare-specific costs and charges
- Medicare reimbursement information
- Settlement information
- Financial statement summaries
- Supporting documentation and exhibits
When Is My Cost Report Due?
Cost reports are due on or before the last day of the fifth month following the end of the provider's fiscal year.
If a due date falls on a Saturday, Sunday, or federal holiday, the report is considered timely if submitted on the next business day.
Special Filing Deadlines
Special filing requirements may apply when:
- A Medicare Provider Agreement terminates
- A Change of Ownership (CHOW) occurs
- Operations cease during the reporting period
In these situations, the cost report is generally due no later than five months following the effective date of the termination or ownership change.
For additional information, visit Handle a Special Filing Situation.
What Happens After Submission?
After your cost report is submitted, Noridian reviews the filing to determine whether all required elements and supporting documentation have been provided.
During the review process:
- The cost report is evaluated for completeness
- Supporting documentation may be reviewed
- Additional information may be requested
- Settlement activities begin
The time required to complete a review may vary depending on the complexity of the filing.
Looking for a settlement letter, NPR, or other cost report correspondence?
For activity available in MCReF, settlement-related documents can often be accessed online without contacting Noridian. Settlement correspondence is typically issued to the provider's designated Cost Report Contact or STAR Contact. Providers should ensure this information remains current by submitting the STAR Contact Change Form (on the Audit and Reimbursement Forms page) whenever contact information changes.
Need access to MCReF?
MCReF requires a CMS Identity Management (IDM) account and appropriate PS&R access. Visit the Medicare Cost Report e-Filing (MCReF) page for registration instructions, user role information, account maintenance requirements, and support resources.
Need to Submit Additional Documentation?
After your cost report has been submitted, Noridian may request additional supporting documentation during a desk review or audit. Providers may be instructed to use GoAnywhere Managed File Transfer (MFT) to securely exchange requested files. Learn More About GoAnywhere.
Cost Report Processing Timelines
To provide visibility into the cost report review and settlement process, the following general processing benchmarks apply. Processing timelines shown below represent general benchmarks and may vary by filing. Providers can use MCReF to monitor the status of individual cost reports and access available correspondence throughout the review and settlement process.
Acceptance or Rejection
Cost reports are reviewed for completeness and will generally be accepted or rejected within 30 days of the receipt date or postmark date.
Tentative Settlement (TS)
A Tentative Settlement (TS) will generally be issued within 90 days of the cost report acceptance date.
Exceptions:
- Providers in active bankruptcy
- Terminated providers
- Providers currently undergoing a Change of Ownership (CHOW)
Midyear Lump Sum Adjustment
If applicable, a Midyear Lump Sum Adjustment may be processed in addition to the Tentative Settlement to help ensure Medicare payments accurately reflect current reimbursement rates.
Modified Desk Review (MDR)
A Modified Desk Review (MDR) is generally completed within 90 days of the cost report acceptance date.
If the provider qualifies for the MDR process rather than a limited review, full desk review, or audit, the Notice of Program Reimbursement (NPR) package will be issued during this same timeframe.
Exception: Providers undergoing a Change of Ownership (CHOW) that are otherwise eligible for the MDR process will receive their NPR package after the ownership change 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 a cost report is selected for a limited review, full review, or audit, final settlement generally occurs 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, Noridian may perform a year-end review and lump sum review.
What Happens if My Cost Report Cannot be Accepted?
If required information is missing or incorrect, Noridian may return the cost report with a deficiency notice explaining what must be corrected and payments may remain suspended until an acceptable report is received.
Incomplete or unacceptable cost reports may result in processing delays and additional requests for information, which can extend review timelines and delay settlement activities. Providers may also be subject to payment suspension, interest or penalty assessments, and other administrative actions until an acceptable cost report is received and approved for processing.
Submitting a complete and accurate filing helps reduce delays and minimizes the need for additional follow-up.
How Can I Monitor My Cost Report?
Providers can use the Medicare Cost Report Electronic Filing (MCReF) application to monitor activity throughout the review and settlement process. Through MCReF, providers can confirm successful submission, track filing status, monitor review progress, access settlement-related correspondence, and view filing history from a centralized location.
For applicable activity, MCReF also provides online access to Interim Rate Review (IRR) letters, Tentative Settlement (TS) letters, Final Settlement documents, and Notices of Program Reimbursement (NPRs).
Learn more on the Medicare Cost Report e-Filing (MCReF) page.
Need a Copy of a Previously Filed Cost Report?
Medicare cost report data is collected by CMS and made publicly available through the Healthcare Cost Reporting Information System (HCRIS).
Providers looking for Medicare cost report data can access available reports through the CMS Cost Reports website.
Requesting a Cost Report Through FOIA
Cost reports may also be requested through the Freedom of Information Act (FOIA).
To help process your request, include:
- Facility name
- Medicare Provider Number (if known)
- State where the facility operates (if the provider number is unknown)
- Fiscal year end of the cost report being requested
- Whether you are requesting:
- The As-Filed Cost Report, or
- The Finalized Cost Report (if available)
- Any specific worksheets being requested, if applicable
Submitting a FOIA Request
FOIA requests for Medicare cost reports and other provider audit and reimbursement records may be submitted using the CMS Freedom of Information Act (FOIA) Request Form.
Specialized Cost Report Topics
Swing Bed Days
Swing Bed Days may affect cost reporting and reimbursement calculations for eligible facilities. Providers should review applicable guidance when preparing cost reports that include Swing Bed activity.
Learn More About Swing Bed Days
Social Security Income (SSI) Elections
Information regarding Federal Fiscal Year (FFY) 2004 and earlier Social Security Income (SSI) Elections remains available for providers needing historical guidance.
Learn More About SSI Elections
