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Corporate

Provider Audit General Information

The Centers for Medicare and Medicaid Services (CMS) regulations require a Medicare cost report to be filed on or before the last day of the fifth month following the close of the period covered by the report.

If the cost report is filed timely and indicates an amount is due the Medicare program, interest will accrue on that amount from the date the cost report is due unless:

  1. Full payment is submitted to the lockbox address, or
  2. You request in writing and we agree in advance to liquidate the overpayment through a reduction in interim payments over the next 30-day period.

Should you fail to file a timely cost report and it is later determined that an overpayment exists, interest will also be assessed on that overpayment. Under Title 42 CFR Section 405.378 (b)(2), interest charges are assessed in thirty-day periods. Thus, if payment is received 31 days from the date of final determination, one 30-day period of interest will be assessed and for each full 30-day period until the debt is paid in full.

In compliance with CMS instructions, any extension of time in filing your report must have prior approval by your contractor. If an extension is needed, you must write us a letter explaining the full details regarding the necessity of the extension.

Cost reports that are not filed timely will result in 100% of the provider's payments being suspended. If you cannot submit your cost report by the due date, you may contact us prior to the cost report due date and request a reduction in the rate of suspension. If there is good cause to approve the request, a recommendation will be made to the CMS Regional Office (RO) that the provider's suspension rate be reduced to 50% for a 60-day period. If the RO concurs, we will change the suspension rate to 50%. If on the 61st day the cost report has not been received the rate of suspension will increase to 100%.

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