Checklist for Home Health and Hospice Cost Report Submission
The following checklist is intended to help a provider ensure all required items are submitted with a home health agency (HHA) or hospice cost report. Please ensure that the following items are included with the cost report submission:
- A CD, flash drive, or diskette containing the Electronic Cost Report (ECR) file prepared on CMS approved vendor software.
- ECR file must pass ALL Level 1 edits.
- Print Image (PI) file of the cost report on the CD, flash drive, or diskette.
- Worksheet S with encryption codes and original signature of Officer or Administrator.
- The encryption code, date, and time displayed on the certification page must match exactly with that of the ECR and PI encryption code, date and time.
- CMS Form 339 with original signature of Officer or Administrator and applicable supporting documents for Home Health Agencies cost reports beginning before October 1, 2015. The new Hospice form 1984-14 for cost reporting periods beginning October 1, 2014, do not require a CMS Form 339. For hospices that are submitting a cost report for a beginning period before October 1, 2014, the CMS Form 339 questionnaire is still required.
- If cost report indicates an amount is due to Medicare, a check made payable to Medicare is mailed under separate cover to the lockbox as follows:
CGS J15 HH and H Region B
PO Box 957124
St. Louis, MO 63195-7124 - A copy of the working trial balance to support expenses.
- Documentation to support reclassification entries, adjustment entries, and related party entries.
- Documentation to support total flu vaccine cost and charges.
Home Health and Hospice cost reports can be sent to:
Regular mail: | Overnight: |
---|---|
CGS Administrators, LLC J15 HHH Audit/Reimbursement P.O. Box 20015 Nashville, TN 37202 |
CGS Administrators, LLC J15 HHH Audit/Reimbursement 26 Century Blvd STE ST610 Ref: 20015 Nashville, TN 37214-3685 |
Updated: 12.19.16