Final Settlement of the Cost Report

90 – Final Settlement of the Cost Report (Rev. 127, Issued: 07-13-07, Effective: 10-01-07, Implementation: 10-01-07) CMS expects that you settle (i.e., issue a Notice of Amount of Program Reimbursement (NPR)) all cost reports that are not scheduled for audit within 12 months of acceptance of a cost report unless you have a documented reason why the cost report cannot be settled (for example bankruptcy, OIG investigation, DOJ investigation). If a settlement has been delayed because a prior year cost report is being audited, that settlement will be considered timely if completed within 6 months of the NPR date of the cost report that was audited. If a provider files an amended cost report and that cost report is not going to be audited, CMS expects that you settle the cost report within the greater of 5 months from the acceptance of the amended cost report, or the time left of the 12 months from the acceptance of the “initial” filed cost report. If you audit a cost report, issue the NPR to the provider within 60 days of the exit conference or within 60 days after the audit adjustments are finalized (using the timeframes described in §60.11 of this chapter) if an exit conference is waived. As a general rule, if proper notification was given to the provider (see §§60.1 and 60.2 of this chapter) and adjustments were proposed due to the “lack of documentation” as described in 42 CFR 413.20 and 42 CFR 413.24, issue the NPR without considering documentation received from the provider after the established timeframes unless there are circumstances that you have previously approved. If the provider used the PS&R settlement data to file the cost report or if you decide to use the PS&R data because the provider’s reported settlement data is not documented properly, settle the cost report using a PS&R with a paid through date no earlier than 120 days prior to the issuance of the final audit adjustment report. If you do not issue an audit adjustment report (e.g., there were no desk review exceptions resolution process adjustments or field audit adjustments), use a PS&R with a paid through date that is no earlier than 120 days prior to the NPR date. If you settle the cost report later than 18 months after the end of the provider’s fiscal year, use a PS&R with a paid through date that is no earlier than 15 months after the end of the provider’s fiscal year.