March 21, 2012 - Revised: 04.17.18
Medicare Cost Report (MCR) Filing Checklist**
Providers filing Medicare Cost Reports must submit the following documents and files:
- Electronic cost report (ECR) file and Print Image (PI) file from an approved software vendor.
- Cost Report certification page (Worksheet S) with encryption dates, times and codes, along with an original hand-written signature from an authorized official.
- If a teaching hospital, Intern and Resident Information System (IRIS) files.
- For RHC and CMHC providers only, a completed cost report questionnaire, CMS Form 339, along with an original hand-written signature from an authorized official.
Supporting Information – All Providers
- Supporting documentation required by the CMS 339 Questionnaire or Worksheet S-2, Part II from the 2552-10, 2540-10, 265-11, 1728-94 and 224-14, as applicable. Including, but not limited to:
- Bad debt Listing (Excel format preferred)
- Working Trial Balance
- Audited Financial Statements, where applicable
- Supporting documentation for reclassifications, adjustments, related organizations, contracted therapists and protested items.
Additional Recommendations
- DSH Days, if applicable. Include a DSH days listing of paid and eligible days that reconcile to the cost report.
- The name, phone number and e-mail address of the cost report preparer should be included in the cost report package.
- Sign your worksheet S in blue ink to ensure it is not mistaken for a copy.
- Electronic files may be submitted on a CD or flash drive.
- Encryption software requiring an .exe file to access the files or access to a provider's network is no longer acceptable.
- Mail all required items in the same package. Mailing the cost report elements in different envelopes may cause delays in processing.
- Do not staple or bind any of the pages.
- If submitting encrypted documentation, please e-mail your password to J15APassword@cgsadmin.com or by mail under separate cover.
- Utilize a reliable carrier when sending the cost report package. Payments are suspended for cost reports not filed timely unless prior approval (see PRM 15-1, section 2413 A.2) was granted.
**This checklist is for filing a full cost report. For information regarding filing a less than full cost report (low utilization or no business), click on the following link:
Revised 12/6/2017