New Uniform Low Utilization Thresholds

New CMS Low Utillization Thresholds - Do I Need To File A Full Cost Report?

CMS issued uniform thresholds for submitting low utilization cost reports. This means that the CMS reimbursement amount is what determines if you qualify for filing a low utilization report (i.e., less than a full cost report); it is no longer left up to each MAC to decide.

Below are the current threshold amounts as of June 19, 2020:

  • Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs): $50,000
  • Community Mental Health Clinics (CMHCs): $15,000 with no outlier payments listed on the PS&R
  • All other providers including Hospitals, SNFs, HHAs, and Hospices: $200,0001

It is worthwhile to note that the amounts are based on the net reimbursement amount for the cost report year that shows up on your PS&R report at the time the cost report is filed. If your facility received periodic interim payments (PIP) and/or lump sum adjustments during the cost report year, then those should be added to the PS&R amount, as well.

You should also note that if there will be pass-through payments being claimed, such as bad debt or vaccine reimbursement, you are not eligible to file a low utilization cost report.

One final note is that if the facility is a complex, meaning that there are several facilities consolidated, such as a provider-based FQHC, the threshold will be the main facility amount, not a sum of the amounts for each facility. For example, if there is an HHA with an HHA-based hospice, the total threshold will still be $200,000, not $400,000.2

  2. Ibid

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