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Low and No Medicare Utilization Cost Report

No Utilization Cost Reports

To comply with program cost reporting requirements, a provider that has not furnished any covered Medicare services during a cost reporting period must only complete the certification page of the cost report (Worksheet S) along with a waiver form certifying no Medicare utilization. Prior approval from the MAC to file a no utilization cost report is not required. 

Items Required to be Submitted for a No Medicare Utilization Cost Report:

Low Utilization Cost Reports

If a provider has been reimbursed $200,000 or less ($25,000 for RHC, $50,000 for FQHC) during the cost report period*, they may qualify to file a low utilization cost report and waive filing of the ECR disk. Prior approval from the MAC to file a low utilization cost report is not required. 

The qualifying criteria to file a low utilization cost report for a provider type other than FQHC and RHC is:

    • Net reimbursement $200,000 or less (Medicare Part A and B) or,

The criteria to file a low utilization cost report for an FQHC is:

    • Net reimbursement $50,000 or less

The criteria to file a low utilization cost report for an RHC is:

    • Net reimbursement $25,000 or less

* There is no longer an option to file a low utilization cost report based on less than 10 percent Medicare utilization. This option was only available for fiscal periods ending 12/31/2016 or earlier.

Items required to be submitted for a low utilization cost report:

    • Certification Page (Worksheet S), containing a valid (ink or electronic) signature by an officer or administrator.
    • Applicable S-series worksheets (see below)
    • Balance sheet and income statement (these can be worksheets from the cost report, ex. F-series worksheets – see below)
    • Signed Low/No Utilization Cost Report Waiver form***form has been updated***
Cost Report Type S Series Worksheets Balance Sheet/Income Statement
SNF 2540-10 Worksheet S, S-3 Pt I G and G-3
Hospital 2552-10 Worksheet S, S-3 Pt I G, G-2, and G-3
HHA 1728-94 Worksheet S, S-3 Pt I F and F-1
Hospice 1984-14 Worksheet S, S-1 Pt II F and F-2
RHC 222-92 Worksheet S, S Pt I Lines 1-5, S Pt II Balance sheet and income statement are required
FQHC 224-14 Worksheet S, S Pt I Lines 1-14 F-1; balance sheet is required
ESRD 265-11 Worksheet F and F-1
CMHC 2088-92 Worksheet S Pts I-IV G; balance sheet is required
    • By filing a no/low utilization MCR, the provider accepts interim payments as final settlement. The MAC reserves the right to require a full cost report if after review it deems it necessary to best serve the interest of the program.
    • All cost reports must be filed via mail/hand delivery or MCReF (available for cost report FYE 12/31/2017 and later).  Submission via NGSConnex or email is no longer available.

Questions regarding Low/No Utilization Cost Report filing:

Contact JK_Cost_Report_Filing@anthem.com or J6_Cost_Report_Filing@anthem.com

For more information, visit the Cost Reports section on this website.

Posted 2/11/2019


Last Modified: 2/11/19
Low and No Medicare Utilization Cost Report
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