Cost Report Structure, Worksheets, and Filing Mechanics
The report as a single, self-consistent model
The hospital Medicare cost report is filed on CMS-2552-10 and is structurally a linked model rather than a stack of independent forms. Worksheet S-2 captures provider demographics, the cost reporting period, and settlement data; an inconsistency between S-2 and the detail schedules is a classic finding. The S-3 series reports hospital-based SNF/NF and other unit data, while S-10 collects uncompensated care. Worksheet A is the trial balance, recording expense by cost center; the A-7 and A-8 series adjust it for capital assets and reclassifications. Worksheet B allocates overhead to revenue-producing centers, Worksheet C derives departmental cost-to-charge ratios, Worksheet E computes the settlement, and Worksheet G holds the balance sheet.
Filing mechanics are testable. A cost report covers a 12-month period and is due by the last day of the fifth month after the period ends, that is, 150 days. The provider must file even if it had no Medicare utilization. Extensions are limited; late filing can forfeit reimbursement and expose the provider to penalties. An authorized official must certify the report, and an unsigned or improperly certified filing is deficient.
Traps: confusing the 150-day deadline with a simple calendar assumption; reporting a change of ownership on the wrong schedule; omitting low- or no-utilization reports; and treating S-10 as optional. Rule of thumb: before submitting, reconcile S-2 bed days, Worksheet A total expense, and Worksheet G fund balance to the audited financial statements. If any leg fails, something upstream is misposted.