Reopenings and Amended Cost Reports

Medicare's Cost Report Worksheet S-10 to Capture Uncompensated Care Data Updates

For Inpatient Prospective Payment System (IPPS) hospitals, CMS has granted an extension from September 30, 2017 until October 31, 2017 for all IPPS hospitals to resubmit certain Worksheet S-10 data. As described in the FY 2018 IPPS/Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), the initial deadline had been September 30, 2017.

For revisions to be considered, CMS is modifying the deadline such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by Medicare Administrative Contractors (MACs) on/before October 31, 2017.

This instruction applies only to Worksheet S-10 of the FY 2014 and FY 2015 cost reports for IPPS hospitals. Revisions to Worksheet S-10 from other fiscal years, revisions to other worksheets of the FY 2014 and FY 2015 cost reports, or revisions to Worksheet S-10 by non-IPPS hospitals are not subject to this instruction.

Resources

Cost Report Worksheet S-10 Revisions

Amending Cost Reports or Requesting Reopenings for Cost Reports to Revise Worksheet S-10 (Hospital Uncompensated and Indigent Care Data)

Provider Types Affected: Inpatient Prospective Payment System (IPPS) hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs) submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Cost Reporting Periods Affected: Cost reporting periods beginning during Fiscal Year (FY) 2014 (cost reporting periods beginning on or after 10/01/13, and before 10/1/14), except when explicitly directed by CMS.

Amended Cost Reports: Providers may amend cost reports that have not been final settled to revise worksheet S-10 to ensure S-10 data is accurate for potential use by CMS in determining fiscal year 2018 uncompensated care payments. For revisions to be considered, hospitals must submit their amended cost report containing the revised Worksheet S-10 (or a completed Worksheet S-10 if no data had been included on the previously submitted cost report) no later than 9/30/16. Submissions received on or after 10/1/16 will not be accepted. This instruction only applies to Worksheet S-10 of FY 2014 cost reports for IPPS hospitals, revisions to Worksheet S-10 from other fiscal years, revisions to other worksheets of the FY 2014 cost reports, or revisions to Worksheet S-10 by non-IPPS hospitals are not subject to this instruction.

Cost Report Reopening Requests: For cost reports beginning in FY14 that have been final settled, providers may request a reopening to revise worksheet S-10 to ensure S-10 data is accurate for potential use by CMS in determining fiscal year 2018 uncompensated care payments. For revisions to be considered, hospitals must submit their reopening request and supporting documentation containing the revised Worksheet S-10 (or a completed Worksheet S-10 if no data had been included on the previously submitted cost report) no later than 9/30/16.  Submissions received on or after 10/1/16 will not be accepted.

See the CMS Medicare Learning Network (MLN) Matters (MM)9648 for further details.

Effective April 1, 2016 a new Cost Report Reopening submission procedure will be implemented.

All Cost Report Reopening requests sent via mail or email to Noridian must be submitted using:

Cost Report Reopening requests submitted to any other physical or email address will not be considered and will be returned to the Sender. Proper submission of the Cost Report Reopening request using the designated PO Box and/or email address will ensure timely processing of the Cost Report reopening request. For questions, contact the Provider Customer Service Center. 

Noridian offer the following guidelines relating to cost report reopening and the filing of amended cost reports.

Cost Report Reopening Requests

A request for a cost report final determination reopening may be honored by Noridian if: 1) new and material evidence has been submitted, or 2) a clear and obvious error was made, or 3) the determination is found to be inconsistent with the law, regulations and rulings, or general instructions.

For purposes of reviewing a request for a reopening, Noridian is defining "new and material evidence" to include any evidence that:

  1. was not readily available or known to the person or entity requesting/initiating the reopening at the time of the initial filing of the cost report; and
  2. may result in a conclusion different from that reached in the initial filing of the cost report.
  3. Noridian uses a cumulative reimbursement materiality threshold of $10,000 as part of their reopening approval/denial criteria.

Noridian defines a "clear and obvious error" as an error that occurred to the initial determination or decision based on incorrect evidence on file on which the determination or decision was based or any evidence of record anywhere in the contractor's Medicare file or in CMS files at the time such initial determination or decision was made.

When submitting a request for a cost report reopening, the request must be in writing from the provider (on provider letterhead), signed by an official of the provider and be received by Noridian no later than 3 years after the date of the initial determination or decision that is the subject of the requested reopening. A request may be submitted by a party on behalf of the provider. If a request is submitted by another party on behalf of a provider, it must include a Letter of Representation (on provider letterhead) signed by an official of the provider. The Letter of Representation must indicate that the designation is applicable to the specific cost report reopening request.

The reopening request should:

  1. Identify the applicable cost reporting period(s).
  2. Identify the issue(s) for which the reopening is being requested.
  3. Identify the reimbursement impact for each issue and meet the cumulative Noridian materiality threshold of $10,000.
  4. Include documentation in sufficient detail to support the request.

A timely-filed provider reopening request will be examined carefully, in accordance with the above regulations, in order to ascertain whether sufficient evidence exists for reopening. Based upon this review, Noridian then has the discretion to either reopen the cost report or deny the request. It is important to note that Noridian, as a contractor, has a great deal of discretion in these matters. It should also be stressed that Noridian will not summarily reject a request for reopening, but will provide adequate rationale for the denial. While not mandated by the regulations, it is Noridian internal policy to respond to a reopening request, either approving or denying the request, within 30 days of receiving the request from the provider.

Providers should note that a determination or decision to reopen or not to reopen a determination or decision is not a final determination or decision and is not subject to further administrative review or judicial review.

Amended Cost Reports

Ordinarily, a cost report filed in a manner consistent with regulations and policy governing its preparation is intended to be final when settlement has been made or following an audit when determined to be necessary by the contractor. However, a cost report may also be considered final when initially delivered to the contractor although the contractor may not have performed its desk review and, if necessary, its audit.  Under limited circumstances Noridian may accept an amended cost report submitted by a provider in order to:

  • correct material errors detected subsequent to the filing of the original cost report.
  • comply with health insurance policies or regulations or,
  • reflect the settlement of a contested liability.

An amended cost report will not be accepted if submitted after the desk review start date unless Noridian determines that it is in the best interest of the program.  Please contact Noridian if you are not sure whether we have started a desk review or if you have other questions about re-filing the report.

All necessary corrections should be included in one amended cost report.  As a general rule, Noridian will not accept a second amended report filed for the same cost report year.

When submitting an amended cost report, please include:

  • a letter stating what is being amended, the reason for the change and the reimbursement effect.
  • adequate supporting documentation.
  • a signed Worksheet S certification page. We recommend using a color other than black for the signature to avoid doubt that it is an original signature and not a photocopy.
  • electronic EC/PI files that pass all level 1 edits.

If this information is not included, the amended cost report will not be accepted and will be returned to the provider.

Matters relating to cost report reopenings and/or amended cost reports should be referred to the audit manager as listed on the Contact Noridian Management webpage.

Resources

  • 42 CFR §413.24
  • Provider Reimbursement Manual PRM 15-1, 2931.2

 

Last Updated Fri, 28 Feb 2020 16:13:39 +0000