Provider Payments Held Due to Untimely Cost Reports

Provider payments held due to untimely cost reports


To ensure that all records of care costs are kept up to date and accurate, the Centers for Medicare and Medicaid Services requires that providers submit cost reports in a timely manner. Providers that do not submit cost reports on time, for whatever reason, could lose out on a significant amount of money. Even a slight error could result in a 30-day payment delay.

Providers need to have a thorough understanding of how to file a cost report.

Why some care providers are experiencing payment holds

In June, claims and transaction processing provider Palmetto GBA reported that a high number of care providers had submitted untimely or incomplete cost reports. As a result, those providers faced payment holds until their reporting information could be completed.

According to Palmetto GBA, the majority of payment withholds were the result of providers submitting cost reports through eServices, but failing to mail in the signed cost report worksheet. The company warned providers that it could take up to 30 days to process the amended forms. Such withholds could prevent providers from receiving the reimbursements they’re owed for an even longer period if they do not immediately complete their forms.

doctor typing Late cost report submission could result in a payment hold.

How to properly file a cost report

Care providers should file cost reports as early as possible. Doing so will ensure payments are received quickly or, in the event there’s an error, it may be amended swiftly. In fact, Palmetto reported that CMS will give providers a grace period to correct errors, based on the number of days the provider filed early.

Submitting cost reports electronically is the most efficient way to do so. Not only is traditional mail less secure, it’s also slower. If your mailed reports do not arrive on time, it is your responsibility to track them down and make sure they get to the right place. Furthermore, electronic submissions eliminate the cost of postage and you get a confirmation of receipt as soon as you submit the reports.

Note that if you send files electronically, there’s no need to send a separate disc through the mail. In fact, doing so could could further issues. However, Palmetto GBA explained that cost reports filed as low or no utilization must be sent as a hard copy. Plus, a hard copy of the signature page is always required.

When your organization leverages integrated software to track patient and administrative data, you gain the power of interoperability. When all of your data can easily transfer between systems, there’s less work to bog down your admin team. In other words, administrators can ensure the information contained with cost reports is accurate, so that fewer claims will be denied. To gain this benefit, your organization needs an electronic health record application it can trust.

As the industry shifts toward value-based care, these reports will become ever more important to your organization’s bottom line. The more you can trust your data, the better you can demonstrate to payers the value of your work.

With award-winning NDoc Software, generating cost reports is intuitive. NDoc is designed specifically for hospice and home health care providers. To learn more about how our solutions can benefit your practice, sign up for a free demo today.