Cost Report Filing

Medicare cost reports are required to be filed each year. A cost report normally covers a 12-month period and must be submitted within five months of the end of provider’s cost reporting period.

Filing the cost report before the due date is strongly recommended, as filing late results in payments being suspended, while filing early establishes a grace period in the event the report is rejected, allowing time to correct and resubmit the report before payments are suspended.

Filing a cost report even a few days late can result in suspended payments for an extended period of time. Suspended payments are not released until the cost report is received and determined to be acceptable. During busy periods, such as the month of June, it may take 30 days to accept the cost report.

Obtain Access to MCReF
The Medicare Cost Report e-Filing (MCReF) system is provided by the Centers for Medicare & Medicaid Services (CMS) to simplify the process of submitting a Medicare Cost Report. MCReF is a secure portal for the transmission of documents (including PII/PHI). Files uploaded are not to be encrypted or password protected. Benefits of using MCReF include:

• Electronic signature is accepted
• Postage expense is eliminated
• PHI is secure
• Confirmation of receipt is received immediately

See Medicare Cost Report e-Filing (MCReF) for information on how to access and use the system. This includes a video overview and a detailed user manual.

Obtain PS&R Report 
Providers are required to obtain their own PS&R report(s) for use in preparing the cost report. Please refer to the following articles for instructions on accessing the system and ordering reports. 

• PS&R: Obtain Access via IDM
• PS&R: Order Summary Report 

Standard Templates 
To streamline the Medicare Cost Report process, CMS provides electronic versions of key cost report exhibits. By using the CMS-provided (optional) version of the exhibits, there should be a reduced need for follow-up communication regarding the cost report submission. When filing using MCReF, a provider will receive preemptive feedback about potential issues with their exhibits.

Click Electronic Cost Report Exhibit Templates to view the entire article in CMS.gov. This section provides information about the exhibits and the Downloads section contains exhibits/templates in an Excel file and specifications/directions in a PDF file. A direct link to each exhibit/template is included below.

Hospital Cost Reports (2552-10)
For cost reporting periods beginning on or after October 1, 2022, hospital cost reports must be filed with listings that support Medicaid Eligible Days (Exhibit 3A), Medicare Bad Debts (Exhibit 2A), Charity Care (Exhibit 3B), and Total Bad Debts (Exhibit 3C). For a description of each template, please review: Standard Templates — Hospital Cost Reports (PDF).

To access a CMS-provided standard template, select from the following:

• Medicare Bad Debts (Exhibit 2A) — Hospital 2552-10
• Medicaid Eligible Days (Exhibit 3A) — Hospital 2552-10
• Charity Care (Exhibit 3B) — Hospital 2552-10
• Total Bad Debt (Exhibit 3C) — Hospital 2552-10

Other provider types: RHC, CMHC, FQHC, ESRD and SNF
A template for reporting Medicare bad debts can be found here: Medicare Bad Debts (Exhibit 1) — Other Providers (XLSX). The specification document for each template is in the Downloads section of Electronic Cost Report Exhibit Templates.

Submit Cost Report
Providers are encouraged to file the cost report and all documentation through MCReF. If MCReF is not used, the cost report can be mailed. However, do not submit through both MCReF and U.S. mail. All submitted cost reports are subject to a desk review and/or an audit.

When making a submission, please be sure to include schedules or working papers for reclassifications, adjustments, related organizations, contracted therapists, and protested items.

MCReF 

• Ensure all files are uploaded, including the electronic signature page 
• Attach cost report files in their native format 
• Bad debt lists should be sent in an Excel file format

Mailing

• Included a printed signature page so the cost report can be identified
• Ensure the cost report is signed (electronic signature is acceptable)
• If signing with a pen, use blue ink
• Place cost report files and supporting documents on a disk or flash drive
• Do not send printed copies of the cost report or documents 
• If sending reports for multiple providers, clearly identify and place files on separate disks
• Attach cost report files in their native format 
• Bad debt lists should be sent in an Excel file format
• Limit paper documents to only the signed, signature page (with encryption codes)

For cost reports sent through the mail, the date mailed is based on the U.S.P.S. postmark and not the date from a postage machine. If a U.S.P.S. postmark is not on the package, the receipt date will be used as the postmark date.