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June 11, 2020

New Defined Thresholds for Medicare Low Utilization Cost Reports

The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Administrative Administrators (MACs) that effective for all cost reports received on or after June 19, 2020, new defined thresholds to determine a Medicare low utilization cost report will be used.

The following defined thresholds to file a low utilization cost report are:

  • Federally Qualified Health Clinics (FQHCs): $50,000
  • Rural Health Clinics (RHCs): $50,000
  • Community Health Mental Health Clinics (CMHCs): $0 CMHCs do not qualify for low utilization as they do not have a threshold/limitation for outlier reconciliations.
  • All Other Providers: $200,000. This includes hospital and non-hospital provider types.

Note1: Total Reimbursement is the sum of the current interim payments on the PS&R, total bi-weekly payments (including Periodic Interim Payments) and total lump sum adjustments.

Note 2: The above thresholds will be applied to the cost report being submitted for the entire provider complex (family). This means if a hospital cost report is being submitted with a provider-based FQHC, the Low Medicare Utilization threshold used will be the $200,000 hospital threshold amount; it will not be $250,000 (which would be the hospital $200,000 threshold plus the FQHC $50,000 threshold)).

The Part A Medicare Cost Report (MCR) Filing Checklist Low or No Utilization Filing Web page has been updated to include this information. For home health and hospice providers, no change was made to the threshold amount. Please refer to the No or Low Utilization Cost Reports web page for additional information.

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