Medicare Cost Report vs. Medicare Credit Balance Report
We receive many inquiries from new providers who are often confused on the difference between the Medicare cost report and the Medicare credit balance report. In order to clarify the differences, we have outlined some of them here. Both reports are required of Medicare reimbursable entities, such as Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), Home Offices, Hospices, Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Hospitals.
What is a Medicare cost report?
Medicare cost reports are financial reports used to report expenses for different types of Medicare reimbursable entities. They are used to set reimbursement rates for providers.
What is a Medicare credit balance report?
Medicare credit balance reports are specifically used to monitor the identification and recovery of “credit balances” due the Medicare program. A credit balance is defined as an improper or excess payment made to a provider as the result of patient billing or claims processing errors. For example, if a provider is paid twice for the same service (e.g., by Medicare and another insurer), then a refund must be made to the secondary payer.
| Medicare cost report | Medicare Credit Balance Report | |
| Filing Frequency | Annual | Quarterly |
| Due Date | 5 Months after year end unless a Chow has occurred | 30 days after each quarter ends |
| Penalty For Not Filing | Payment Suspension Until Filed | Payment Suspension Until Filed |
| Current Form Number | Hospital – 2552-10
Skilled Nursing Facility – 2540-10 Home Health Agency – 1728-94 Rural Health Clinic – 222-92 Organ Procurement Organization – 216-94 End Stage Renal Disease – 265-11 Community Mental Health Clinic/CORF – 2088-92 Hospice – 1984-99 Home Office – 287-05 Federal Qualified Health Center – 224-14 |
CMS 838 |
| Where to File | Medicare Audit Contractor (MAC) | Medicare Audit Contractor (MAC) |
| Electronic Filing Required? | Yes if Filing a Full Cost Report(>$200,000 Net Reimbursement) | No |