Medicare Cost Report Pre-Audit QA API Reference

Beta. Pre-audits one hospital cost report (Form CMS-2552-10): the ECR file against the record specifications and level 1 edits in CMS Pub. 15-2, chapter 40, section 4095; the ties between Worksheets S, A, B, C, D and E; Worksheet S-10 line by line; the Exhibit 2A, 3B and 3C listings against the amounts claimed and 42 CFR 413.89; and the deadline in 42 CFR 413.24(f)(2). A math check: it does not judge allowability. Product page and free test form.

Endpoint

Parameters

Any other parameter is refused, so a typo never changes the result quietly.

The package

Files are recognized by content, not by name. Listings are .xlsx in the CMS template layout, or .csv laid out in the same grid (the exhibit identifier in A1 and B1, the header labels in column A with values in column B, then the column labels and the column number row). Sheets without the identifier are ignored, as MCReF ignores them.

Which listings are required comes from the cost report: Exhibit 2A when Worksheet E, Part A, line 64, Part B, line 34 or S-10, line 27.01 claims Medicare bad debts; Exhibit 3B when S-10, line 20 claims charity care; Exhibit 3C when S-10, line 26 reports bad debts. A sole community hospital whose Worksheet E, Part A, line 48 is greater than line 47 does not need 3B or 3C.

Patient data

The pre-audit does not accept PHI. Before upload, in your own copy of the listings: replace every account number with a pseudonymous row ID, the same for the same account across listings and years; delete the patient name and MBI columns (columns 1, 2 and, on Exhibit 2A, 6), or leave them blank; put Y in Exhibit 2A column 7 instead of a Medicaid number; and shift every date, including the FYB and FYE header cells, by one number of days of your choosing. Send the period shifted by the same number. The ECR file goes as it is.

Every listing check counts days between dates, so a uniform shift leaves the findings unchanged. The real period comes from the ECR file and is used for the format checks and the deadline only. The engine compares it with the shifted period for two things and nothing else: a listing period equal to the real one is refused as not shifted, and a period whose length differs is refused as not shifted as a block. The offset is never worked out, kept or reported.

Refused before any check, with the file, row and column and no charge: an MBI pattern, a HICN, a Social Security number, an account or Medicaid number pattern (8 or more digits in a row), text that reads like a patient name (Last, First; Mr. or Mrs. and a name; DOB, SSN or MRN labels; two words as an account ID), anything in the name or MBI columns, and a Medicaid number other than Y. The value itself is never repeated. If no write-off date falls inside the period entered, one LIST-SHIFT warning says the period and the listings were probably shifted by different numbers.

Reports contain no dates. Listing findings give the row number and your row ID, and state positions in days (for example, 63 days after the first bill, or 9 days after the period ends).

Report

Each finding

Rule IDs

Source keys, as returned in every report:

• 42 CFR 413.24(f)(2): due dates for cost reports
• 42 CFR 413.24(f)(5): an acceptable cost report submission, the listings it needs and the ECR Specifications Manual
• 42 CFR 413.89: bad debts, charity and courtesy allowances, including the 120-day collection effort
• CMS Pub. 15-2, chapter 40 (Form CMS-2552-10), Transmittal 26, June 30, 2026: worksheet instructions, Exhibits 2A, 3B and 3C, and the ECR specifications in section 4095
• CMS electronic cost report exhibit templates and specifications for Exhibits 2A, 3B and 3C
• CMS Healthcare Cost Report Information System (HCRIS) cost report data, used for the test corpus

Not checked

• Whether any cost, bad debt or charity care amount is allowable, or what Medicare will pay. That is the MAC's judgment, and a PASS does not decide it.
• Cost finding choices: statistics, allocation bases, reclassifications and adjustments are taken as filed.
• Collection effort documentation, indigence determinations, Medicaid remittance advices and the bad debt collection policy. Only the dates and amounts in the listings are checked.
• Whether the listings match your patient accounting system.
• The type 4 encryption code. Only approved vendor software can produce it; the check confirms the records are there.
• Listings for components other than the hospital (subprovider, SNF and other CCNs) are checked row by row but not tied to their worksheets.
• Worksheets and edits outside this list: the full set of level 1 and level 2 edits runs in your vendor software and again at the MAC.

Example responses

A paid pre-audit of the clean sample, and the findings from a demo run of the sample with errors. Both generated by running the real endpoint code.

{
  "requestId": "7f3c2a1e-5b8d-4c6f-9e0a-1d2b3c4d5e6f",
  "api": "hcris-preaudit-qa",
  "mode": "paid",
  "charged": true,
  "priceCents": 20000,
  "balanceCents": 30000,
  "report": {
    "schemaVersion": 1,
    "status": "PASS",
    "summary": "The ECR file is in the CMS format, the worksheets tie, S-10 recomputes and the listings support the amounts claimed. Ready to file, as far as these checks go.",
    "checkedAgainst": {
      "transmittal": "CMS Pub. 15-2, chapter 40, Transmittal 26 (June 30, 2026)",
      "ecrSpecification": "ECR specification dated 2026181, valid for cost reporting periods ending on or after June 30, 2026, with the record layouts and edits in section 4095",
      "specDate": "2026181"
    },
    "file": {
      "ccn": "999208",
      "ecrSpecDate": "2024275",
      "records": 2567,
      "dataRecords": 2473,
      "labelRecords": 89,
      "type4Records": 3
    },
    "periodDays": 365,
    "deadline": {
      "daysLeft": 16,
      "measuredFrom": "the asOf date you sent",
      "status": "on-time",
      "rule": "The last day of the fifth month after the period ends, or 150 days after a period that ends mid-month (42 CFR 413.24(f)(2))."
    },
    "checks": {
      "ecrFormat": "pass",
      "crossTies": "pass",
      "s10": "pass",
      "listings": "pass",
      "deadline": "pass"
    },
    "listings": {
      "found": [
        {
          "exhibit": "2A",
          "file": "MedicareBD_IP_999208.xlsx",
          "kind": "IP",
          "component": false,
          "rows": 14
        },
        {
          "exhibit": "2A",
          "file": "MedicareBD_OP_999208.xlsx",
          "kind": "OP",
          "component": false,
          "rows": 8
        },
        {
          "exhibit": "3B",
          "file": "Charity_999208.xlsx",
          "kind": null,
          "component": false,
          "rows": 9
        },
        {
          "exhibit": "3B",
          "file": "Charity_component_999208.xlsx",
          "kind": null,
          "component": true,
          "rows": 2
        },
        {
          "exhibit": "3C",
          "file": "TotalBD_999208.xlsx",
          "kind": null,
          "component": false,
          "rows": 297
        },
        {
          "exhibit": "3C",
          "file": "TotalBD_component_999208.xlsx",
          "kind": null,
          "component": true,
          "rows": 1
        }
      ],
      "required": {
        "2A": true,
        "3B": true,
        "3C": true
      },
      "status": {
        "2A": "pass",
        "3B": "pass",
        "3C": "pass"
      },
      "priorYearListings": 0,
      "priorClaimCheck": {
        "2A": "not run: add last year's listing to the package",
        "3B": "not run: add last year's listing to the package",
        "3C": "not run: add last year's listing to the package"
      },
      "schExemptFromS10Listings": false,
      "unrecognizedFiles": 0
    },
    "tiesChecked": 823,
    "ruleCounts": {},
    "findingCount": 0,
    "findingCounts": {
      "error": 0,
      "warning": 0
    },
    "findings": [],
    "findingsTruncated": false,
    "scope": "A pre-audit math check: is the ECR file in the CMS format, do Worksheets S, A, B, C, D and E tie, does Worksheet S-10 recompute, and do the listings support what is claimed. A PASS is not MAC acceptance and does not determine allowability or payment.",
    "input": {
      "format": "zip",
      "bytes": 52765,
      "files": 7
    },
    "inputSha256": "38ba820af5f22bbe8f4ba3a2710764d438d0cb08cc31288f0770fc37bd15fa57"
  }
}

[
  {
    "severity": "error",
    "ruleId": "TIE-A-B",
    "message": "Worksheet B, Part I, column 0 must carry the total direct cost from Worksheet A, column 7, for the same line.",
    "source": "wb",
    "worksheet": "B, Part I",
    "line": "60",
    "column": "0",
    "expected": 1436978,
    "actual": 1441978,
    "group": "crossTies"
  },
  {
    "severity": "error",
    "ruleId": "BD-120-DAYS",
    "message": "Written off 60 days after the first bill. Collection effort must last at least 120 days after the first bill before the account is written off (42 CFR 413.89(e)(2)(i)(A)(5)).",
    "source": "413.89",
    "exhibit": "2A",
    "file": "MedicareBD_IP_999208.xlsx",
    "row": "23",
    "column": "17",
    "expected": "120 days or more",
    "actual": "60 days",
    "group": "listings"
  },
  {
    "severity": "error",
    "ruleId": "BD-BILL-120",
    "message": "The first bill went out 287 days after the later remittance advice. The beneficiary must be billed within 120 days of it (42 CFR 413.89(e)(2)(i)(A)(3)).",
    "source": "413.89",
    "exhibit": "2A",
    "file": "MedicareBD_IP_999208.xlsx",
    "row": "23",
    "column": "13",
    "expected": "120 days or fewer",
    "actual": "287 days",
    "group": "listings"
  },
  {
    "severity": "error",
    "ruleId": "BD-CAP",
    "message": "The allowable bad debt (column 23) is more than the deductible and coinsurance (columns 20 and 21) less recoveries and payments (columns 18 and 22). Medicare bad debt can only come from unpaid deductible and coinsurance.",
    "source": "413.89",
    "exhibit": "2A",
    "file": "MedicareBD_IP_999208.xlsx",
    "row": "29",
    "column": "23",
    "expected": "at most 1126.45",
    "actual": 1276.45,
    "group": "listings"
  },
  {
    "severity": "error",
    "ruleId": "LIST-MISSING",
    "message": "Worksheet S-10, line 20 claims charity care but no Exhibit 3B listing is in the package. A cost report is rejected without the listing that supports the charity care claimed (42 CFR 413.24(f)(5)(i)(D)).",
    "source": "413.24(f)(5)",
    "exhibit": "3B",
    "group": "listings"
  },
  {
    "severity": "error",
    "ruleId": "TBD-DUPLICATE",
    "message": "Account B0000005 is listed twice for the same dates of service (rows 18 and 19). Claim each account once.",
    "source": "ex3c",
    "exhibit": "3C",
    "file": "TotalBD_999208.xlsx",
    "row": "19",
    "column": "5",
    "actual": "account B0000005",
    "group": "listings"
  },
  {
    "severity": "error",
    "ruleId": "S10-LINE",
    "message": "Line 30 (cost of uncompensated care) must be line 23, column 3 plus line 29.",
    "source": "s10",
    "worksheet": "S-10, Part I",
    "line": "30",
    "column": "1",
    "expected": 453134,
    "actual": 465134,
    "group": "s10"
  }
]

Errors

See the shared error table. Rejected and not charged: a body that is not an ECR file or a .zip with one, a package over 4 MB (HTTP 413), more than one ECR file, a missing or malformed period, a period beginning before October 1, 2022, an unknown parameter, a listing with PHI patterns, a listing period that is not shifted or not shifted as a block, an .xls listing, a package too large to finish in time, and on the demo endpoint anything other than a sample package. Example, a PDF (HTTP 400):

{
  "error": {
    "code": "input_error",
    "message": "This is a PDF. Send the ECR file (the text file your cost report software exports for MCReF), or a .zip with the ECR file and the listings. Nothing was charged.",
    "requestId": "7f3c2a1e-5b8d-4c6f-9e0a-1d2b3c4d5e6f",
    "charged": false
  }
}

Code samples

curl -X POST "https://www.spreadrun.com/api/v1/hcris-preaudit-qa?periodStart=2022-10-04&periodEnd=2023-10-03" \
  -H "Authorization: Bearer $SPREADRUN_API_KEY" \
  -H "Content-Type: application/zip" \
  --data-binary @package.zip