Medicare Cost Report Pre-Audit QA

No to both. A PASS means the ECR file is in the CMS format, the worksheets tie, S-10 recomputes and the listings support what the report claims. A PASS is not MAC acceptance and does not determine allowability or payment. The MAC runs its own edits, desk review and audit, and the amounts you claim remain your responsibility.

The ECR file your cost report software exports for MCReF, as it is, and the listings that support it, de-identified: Exhibit 2A for Medicare bad debts (inpatient and outpatient), Exhibit 3B for charity care and Exhibit 3C for total bad debts, in the CMS template layout as .xlsx or as .csv in the same grid. Zip them together, or pick them all in the form and the browser zips them. Add last year's listings, prepared the same way with the same shift, and the check also looks for accounts claimed again.

Real dates of service are PHI, so they never leave your hands. Every listing check measures days between dates: a write-off inside the period, 120 days of collection effort after the first bill, a bill within 120 days of the remittance advice. Move every listing date and the period by the same number of days and each of those counts stays the same, so the findings do too. The filing deadline comes from the real period in the ECR file, which is public cost report data.

It is refused before any check runs, without a charge, with the file, row and column. The check looks for MBIs, HICNs, Social Security numbers, long account or Medicaid numbers, and text that reads like a patient name, and for anything in the name or MBI columns. A listing whose period is the real one, not shifted, is refused too. Reports name rows by row number and your row ID and give day counts, never dates.

Worksheet B, Part I, column 0 against Worksheet A, column 7, line by line; the step-down total on Worksheet B; Worksheet B, column 26 into Worksheet C, column 1; Worksheet C totals, line 202 and total charges; Worksheet D, Part V into Worksheet E, Part B, line 1; the 35 percent bad debt reduction on Worksheet E; and every line of Worksheet S-10 that is a calculation, including lines 27 and 27.01 against Worksheet E and the other worksheets the instructions name. Each finding gives the worksheet, line, column, expected and actual.

The ones the cost report itself calls for. Medicare bad debts on Worksheet E need Exhibit 2A; charity care on S-10, line 20 needs Exhibit 3B; bad debts on S-10, line 26 need Exhibit 3C. A cost report filed without the bad debt or charity care listings that correspond to the amounts claimed is rejected and treated as if it had never been filed (42 CFR 413.24(f)(5)). Each listing must add up to the line it supports.

From 42 CFR 413.89 and the Exhibit 2A instructions: the account written off inside the cost reporting period, at least 120 days of collection effort after the first bill, the first bill within 120 days of the remittance advice, the allowable amount no larger than the deductible and coinsurance less payments and recoveries, the Medicaid remittance date for dual eligible beneficiaries, and the order of the write-off dates. Indigent and dual eligible beneficiaries follow their own rules and are not held to the 120 days.

CMS Pub. 15-2, chapter 40, Transmittal 26 (June 30, 2026), with ECR specification 2026181. Every report prints it. A file built to an older specification than the one in effect for its period end gets a warning. This version checks cost reporting periods beginning on or after October 1, 2022, the periods that use Exhibits 2A, 3B and 3C.

On or before the last day of the fifth month after the period ends: a June 30 year end is due November 30, a December 31 year end May 31. A period that ends mid-month is due 150 days later. Extensions are granted only for extraordinary circumstances beyond your control, such as a flood or fire (42 CFR 413.24(f)(2)). Past the date, the report warns and still checks the rest.

When the pre-audit finishes and returns a report, whether it says PASS, WARN or FAIL: $200.00 per completed pre-audit. Requests rejected before a report exists are free, such as a file that is not an ECR file, a package over 4 MB, a missing period, or a listing with patient identifiers.

Yes, on the two sample packages on this page: a clean cost report with its listings, and the same report with planted errors. The ECR file in both carries the amounts of a real cost report from the CMS HCRIS dataset with the hospital's name, address and CCN replaced; the listings are invented. They run free, up to 10 times a day. Your own cost report is the paid pre-audit: sign in with enough credit and run it from the same form, or call the API.