CMS Pub. 100-06, ch. 8, § 10.1

For cost reports ending prior to January 31, 2009

In accordance with the Provider Reimbursement Manual, Part II (PRM-II), § 104,

providers that continue to participate in the Program and are required to submit a cost

report must do so within 5 months of their cost reporting fiscal year end or 30 days after

receipt of valid Provider Statistical and Reimbursement (PS&R) reports from the

contractor, whichever date is later. Exceptions to this due date for “no Medicare

utilization” cost reports are addressed in PRM-II, §110.A.

If the provider fails to file the cost report by the last day of the fourth month following

the close of its cost reporting period, the contractor is required to send a reminder letter to

the provider to help ensure that the cost report will be filed timely. (This letter may be

sent sooner if the contractor wishes to send it at the time it sends the PS&R summary

reports.) The reminder letter informs the provider of the due date for filing the cost report

and the penalty for not filing the cost report timely. Furthermore, the reminder letter

should include a statement that if the cost report cannot be submitted by the due date, the

provider may request a reduced payment suspension rate of 50 percent during a grace

period of 60 days. The reminder letter should specify that this request should be

submitted before the due date of the cost report. Also, either in the reminder letter or the

letter transmitting the PS&R summary report, the contractor shall notify each provider

that all submitted cost reports are subject to a desk review and/or an audit.

If the contractor receives a request for a reduction in the rate of suspension either because

the cost report will not be filed timely or because the submitted cost report was rejected

and believes that the request should be approved, the contractor should recommend to the

Regional Office (RO) that the provider’s suspension rate be reduced to 50 percent (or a

different rate if appropriate because of unique circumstances) for a 60-day grace period.

The contractor should maintain a copy of the RO’s approval/disapproval of this request in

the provider’s file.

PRM-II, §§104.A.3 and 104.B.2 specify that the provider must receive the PS&R report

on or before the 120th day following the close of a provider’s cost reporting period.

Therefore, the contractor is required to furnish each provider with a copy of the year-to-date summary PS&R reports by the 120th day after the end of the provider’s cost

reporting period. These PS&R reports (by type) should split the summary data into

appropriate portions of the provider’s cost reporting period as dictated by the Medicare

reimbursement policies (e.g., federal payments need to be split as specified in PRM-II,

§3 630 in order to calculate the indirect medical education and disproportionate share

hospital payments). A split may also be necessary because of the provider’s unique

situation. Having the split PS&R reports will enable the provider to file the cost report

accurately. (See Chapter 9 of this manual for detailed description of the PS&R reports.)

If a provider requests detailed PS&R data (e.g., payment reconciliation report) to

reconcile their records with your records, furnish an annual detailed PS&R reports at no

cost to the provider. If a provider requests interim (other than annual) detailed PS&R

report data, provide the detailed data at intervals requested by the provider as long as they

are reasonable. You may charge the provider a fee for this extra service. The fee should

be reasonably related to costs you incur for the added service and be commensurate with

your charge to all other providers for similar data.

Furnish the PS&R reports on electronic media, when cost effective, or on paper. The

provider is expected to make reasonable efforts to process electronic media.

For cost reports ending on or after January 31, 2009

In accordance with the Provider Reimbursement Manual, Part II (PRM-II), § 104,

providers that continue to participate in the Program and are required to submit a cost

report must do so within 5 months of their cost reporting fiscal year end. Exceptions to

this due date for “no Medicare utilization” cost reports are addressed in PRM-II,

§110.A.

The Redesigned PS&R system (PS&R Redesign) shall be utilized for all cost reports

with fiscal years ending January 31, 2009 and later. The PS&R Redesign allows

providers to obtain their own PS&R reports needed to file the cost report. The

contractor is not required to send the provider their PS&R reports, unless the provider

cannot access the system, and informs the contractor of the issue.

If the provider has not already filed its cost report by the last day of the third month

following the close of its cost reporting period, the contractor is required to send a

reminder letter to the provider to help ensure that the cost report will be filed timely. The

reminder letter shall:

• Inform the provider of the due date for filing the cost report and the penalty for

not filing the cost report timely,

• Include a statement that if the cost report cannot be submitted by the due date, the

provider may request a reduced payment suspension rate of 50 percent during a

grace period of 60 days,

• Specify that this request should be submitted before the due date of the cost

report,

• Include a reminder to the provider that they must obtain their own PS&R reports

needed to file to the cost report, and if they are unable to obtain their reports,

they should contact their contractor immediately or run the risk of payment

suspension for lack of timely filing, and

• Notify each provider that all submitted cost reports are subject to a desk review

and/or an audit.

If the contractor receives a request for a reduction in the rate of suspension either

because the cost report will not be filed timely or because the submitted cost report was

rejected and believes that the request should be approved, the contractor should

recommend to the Regional Office (RO) that the provider’s suspension rate be reduced to

50 percent (or a different rate if appropriate because of unique circumstances) for a 60-day grace period. The contractor should maintain a copy of the RO’s

approval/disapproval of this request in the provider’s file.

If the provider is unable to obtain access to the PS&R system, or cannot obtain their

PS&R reports, and they contact their contractor for assistance, the contractor shall

instruct the provider how to obtain their reports. The contractor may assist the

provider by supplying them with the needed reports. Note that failure by the provider to

contact the contractor in a timely manner does not warrant an automatic extension of

the cost report due dates and could result in the provider’s inability to file the cost

report timely and thus be subjected to payment suspension.

The year-to-date summary PS&R reports needed by the provider (by type) should split

the summary data into appropriate portions of the provider’s cost reporting period as

dictated by the Medicare reimbursement policies (e.g., federal payments need to be split

as specified in PRM-II, §3630 in order to calculate the indirect medical education and

disproportionate share hospital payments). A split may also be necessary because of the

provider’s unique situation. Having the split PS&R reports will enable the provider to

file the cost report accurately. PS&R Users may enter any date range in the PS&R

system to accommodate these splits. (See Chapter 9 of this manual for detailed

description of the PS&R reports.)

The provider may also request detailed PS&R data (e.g. payment reconciliation report)

to reconcile their records. The request is input by the provider using the PS&R

Redesign, but due to the sensitive data contained within these reports, the contractor

must approve the request, and send the reports to the provider via secure media (i.e.

password protected CD). The contractor shall furnish a requested detailed PS&R report

annually at no cost to the provider. If a provider requests interim (other than annual)

detailed PS&R report data, provide the detailed data at intervals requested by the provider

as long as they are reasonable. You may charge the provider a fee for this extra service.

The fee should be reasonably related to costs you incur for the added service and be

commensurate with your charge to all other providers for similar data.