A facility will qualify for filing a low-utilization Medicare cost report by meeting EITHER ONE (NOT both) of the following limits:

Projected Payments - Less than $200,000 in annual Medicare A and B net reimbursement (total of all Medicare A and B revenue and contractual allowance account balances per the facility's general ledger for the year ended December 31, 2010, or an estimate thereof if filing using projected numbers).   The Projected Total Reimbursable Cost will be the same as the amount reported on the Projected Total Medicare Payments line.

OR

Projected Days/Visits - Less than 10% Medicare utilization, calculated as:  total annual Medicare days/visits provided divided by total annual census days/visits provided (total census days/visits excludes "held bed" days).

The approval process, which has no specific filing date and can be initiated as soon as the provider's 2010 Medicare activity can be reasonably estimated, is as follows:

1.  If one of the limits above will be met, the provider will file a "Request for Waiver of Electronic Filing of Medicare Cost Report" and fax the completed request to National Government Services (NGS) at (315)442-4980.  PLEASE NOTE that NGS will ultimately compare the projected Medicare data to the final PS&R report to determine compliance with the limit.   Click here for a copy of the waiver form for your convenience.

2.  Provider will receive a "Notice of Approval" letter from NGS that will also indicate the filing requirements and filing deadline.