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No or Low Utilization Cost Reports

No Medicare Utilization

A full cost report need not be filed when a provider has not furnished any covered services to Medicare beneficiaries for an entire cost reporting period. In these cases, the provider must submit a completed worksheet S of the applicable cost report form with an original signature of an authorized official. A signed statement identifying the no utilization cost reporting period also must be submitted. This statement must indicate that no covered services were furnished and no claims for Medicare reimbursement will be filed for the cost reporting period.

Low Medicare Utilization

A provider may file less than a full cost report if it had low utilization of covered services by Medicare beneficiaries in a cost reporting period and is willing to accept their interim payments as full reimbursement for the services rendered in that period. Current requirements are that Medicare reimbursable cost must not exceed $200,000. This amount includes both cost and fee reimbursed services. The following information is required to be submitted with a low utilization cost report:

  • Low Utilization HHAs complete Worksheet S, Parts I & II, S-2, S-3, Parts I-IV, S-5 (if applicable), F, F-1 & F-2.
  • Low utilization Hospices complete Worksheet S, Parts I & II, S-1, G, G-1 & G-2 of the Form 1984-99 or Worksheet S, Parts I & II, S-1, F, F-1, and F-2 of the Form 1984-14.
  • The officer's signature on the certification statement
  • The balance sheet
  • Statement of income and expense
  • Other financial and statistical data the contractor may deem appropriate.

Low Medicare utilization providers may submit the required worksheets on a CMS approved vendor system in hard copy. ECR submission is not required and the edits are not enforceable.

The due date for a no or low Medicare utilization cost report is the same as required for a full cost report. Please use the address on the Provider Audit Contact Information page to submit a request to file a no or low Medicare utilization cost report.

Updated: 12.21.15

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