How Much Does Medicare Cost Report Preparation Cost? Flat Fee vs Hourly
Christian Soriaga, CPA7 min read
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Quick answer: Medicare cost report preparation is priced either as a flat fee or by the hour, and the difference matters more than the number. At Soriaga & Associates, LLC, our cost reports are flat: $1,599.99 for low or full utilization and $500 for no utilization, with a 72-hour turnaround once your documents are complete.
Under 42 CFR 405.371(d)(1), if a provider misses the deadline for an acceptable cost report, "payment to the provider is immediately suspended in whole or in part until a cost report is filed" (eCFR, 42 CFR 405.371).
If you run a Medicare-certified home health agency or hospice, you already know the cost report is not optional. What you may not know is what it should cost. Prices are rarely posted, so owners end up comparing quotes that are built on different assumptions. This guide explains the pricing models, what moves the price, what is included in ours, and what to ask before you sign. It does not compare us to any other firm's prices, because we cannot verify them.
Key takeaways
- Our published fees are flat: $1,599.99 for a low- or full-utilization report and $500 for a no-utilization report. See our pricing page.
- Flat fee vs hourly is a risk question. A flat fee puts the risk of surprises on the preparer. Hourly puts it on you.
- Records drive effort. A cost report built on clean, reconciled books is faster and cheaper to prepare than one that needs cleanup first.
- Late filing has a real cost. Medicare payments can be suspended until an acceptable cost report is filed.
- Prior-year and amended reports are quoted separately, on a free call, because scope varies.
- Ask for the scope in writing before work starts.
Want the exact fee for your agency? Book a free 20-minute call and we will confirm your report type and send the quote in writing.
How much does Medicare cost report preparation cost?
There is no government-set price for preparing a cost report, and we found no neutral source that publishes a market rate. So the honest answer is that it depends on the preparer's billing model and on your situation.
Here is what we can state with certainty. At Soriaga & Associates, LLC:
- A low- or full-utilization home health (CMS-1728-20) or hospice (CMS-1984-14) cost report is $1,599.99.
- A no-utilization report is $500.
- Turnaround is 72 hours once your documents are complete.
- The fee is the same wherever your agency is located.
Both are flat fees, so you know the price before we start. Our pricing page lists every published fee.
Flat fee vs hourly: which is better for a cost report?
| Flat fee | Hourly | |
|---|---|---|
| You know the total up front | Yes | No, only an estimate |
| Who carries the risk of extra work | The preparer | You |
| Calling with a question | No meter running | Often billed |
| Best for | A defined annual filing | A small, well-scoped task |
| Watch for | What is excluded | Vague estimates and no cap |
A cost report is a repeating, well-defined deliverable. That is exactly the kind of work a flat fee suits. Hourly billing is not wrong, but ask for a written estimate and a cap, so a messy ledger does not turn into an open-ended bill.
What drives the cost of a cost report?
Whatever the billing model, the same factors decide how much work, and therefore how much money, a cost report takes.
Utilization type
Worksheet S uses an indicator for the report type: full, low or no Medicare utilization. A no-utilization report means your agency furnished no covered services to Medicare beneficiaries during the entire cost reporting period, so there is much less to prepare. Low utilization requires prior approval from your Medicare Administrative Contractor (MAC). These are different things, and the right type should be confirmed before you quote or file.
The condition of your books
The cost report starts from your general ledger. If months are unreconciled, payroll is miscoded or visits are not tied to revenue, someone has to fix that first. That cleanup is real work whoever does it. If your books are behind, see our catch-up bookkeeping service.
Prior-year and amended reports
A late prior-year report or an amendment to a filed one involves more than a current-year filing. For that reason, we quote prior-year and amended reports on a free call instead of posting a flat number.
Audit support
Preparing a report is one job. Responding to a MAC desk review or audit is another. Ask whether audit support is included or billed separately.
Hospice cap calculation
For hospices, the aggregate cap is a separate filing, not part of the cost report. The hospice files a self-determined cap calculation with its MAC within five months after the cap year ends (42 CFR 418.308(c)). If you want the details, read our hospice aggregate cap explainer. Ask any preparer whether the cap is in the quote.
What is included in our flat fee, and what is extra?
Included:
- Preparation of your complete Medicare cost report
- Preparation and review by CPAs
- Electronic filing through MCReF with your MAC
- 72-hour turnaround once your documents are complete
Quoted separately: prior-year and amended cost reports, and IDOA cost reports. These are quoted on a free call and sent to you in writing before any work begins.
Cost reports go to the MAC as an electronic cost report (ECR) file, commonly through the CMS MCReF portal. They are not filed through iQIES.
What does it cost to file a cost report late?
The price of preparation is small next to the cost of missing the deadline.
The due date. Under 42 CFR 413.24(f)(2)(i), cost reports are due on or before the last day of the fifth month following the close of the period covered by the report. For a calendar-year agency, that is May 31. Use our cost report deadline calculator to find your date. For more on timing, see when the Medicare cost report is due.
Extensions. The contractor may grant an extension only for extraordinary circumstances over which the provider has no control, such as flood or fire, that significantly affect operations (42 CFR 413.24(f)(2)(ii)). Do not plan on one.
The consequence. Under 42 CFR 405.371(d)(1), payment to the provider is suspended in whole or in part until a cost report is filed. We found no published dollar penalty for late filing. The cost is the cash you do not receive while the hold is in place. For an agency that depends on Medicare payments, that can be far more than the preparation fee.
How to prepare so the price stays low
Preparation moves faster when the documents are ready. Our free cost report document checklist (PDF) lists what we ask for. In general, expect to gather:
- Your general ledger and trial balance for the full cost reporting period
- Payroll records by employee and role
- Visit or service statistics
- Prior-year cost report and any MAC correspondence
- Your Provider Statistical and Reimbursement (PS&R) report
Our turnaround clock starts when documents are complete (we confirm what we need on a free call), so a complete package is the fastest way to a finished report. Page-level detail is on our home health cost report and hospice cost report pages.
Questions to ask any cost report preparer
- Is the price flat or hourly? If hourly, ask for an estimate and a cap.
- What report type is this? Full, low or no utilization, and who confirms it.
- What is excluded? Prior-year, amended, audit support, hospice cap.
- Who prepares and who reviews? Ask whether a CPA reviews every report.
- How do you file? The answer should be an ECR file to the MAC, such as through MCReF.
- What is the turnaround, and when does the clock start?
- Will you put the scope and fee in writing?
Be cautious of any guarantee about audit outcomes or payment amounts. If you want these answers from us, book a call and we will go through them with you.
Ready for a fee in writing? Tell us your fiscal year end and report type. Book a free 20-minute call with Christian Soriaga, CPA.
Frequently asked questions
How much does Medicare cost report preparation cost?
It depends on how the preparer bills. At Soriaga & Associates, LLC, a Medicare cost report is a flat fee: $1,599.99 for a low- or full-utilization report and $500 for a no-utilization report. Other firms may bill hourly or by scope, so ask for the basis in writing.
Is a flat fee better than hourly billing for a cost report?
A flat fee gives you the price before work starts, so you can budget and call with questions without a meter running. Hourly billing can work for a small, well-defined task, but the total depends on how clean your records are.
What happens if my cost report is filed late?
Under 42 CFR 405.371(d)(1), if you miss the deadline for an acceptable cost report, payment to the provider is suspended in whole or in part until a cost report is filed. We found no published per-day penalty amount, but a payment hold is costly on its own.
What is not included in the flat fee?
Prior-year and amended cost reports are quoted on a free call, because the work depends on what needs to be filed or corrected. IDOA cost reports are also quoted separately.
How long does preparation take?
Our turnaround is 72 hours once your documents are complete. Missing documents are the usual cause of delay, which is why we send a checklist.
Can I get an extension on the due date?
Only in narrow cases. The regulation lets the MAC grant an extension only for extraordinary circumstances outside your control, such as flood or fire, that significantly affect operations. It is not a routine request.
Sources
- eCFR, 42 CFR 413.24(f)(2) (cost report due date and extensions): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-413/subpart-B/section-413.24
- eCFR, 42 CFR 405.371(d)(1) (suspension of payment for failure to file a cost report): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-405/subpart-C/section-405.371
- eCFR, 42 CFR 418.308(c) (hospice cap self-determination, filing within five months): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-G/section-418.308
- CMS, Medicare Cost Report E-filing (MCReF): https://www.cms.gov/medicare/audits-compliance/part-a-cost-report/medicare-cost-report-electronic-filing-mcref
- CMS, Provider Reimbursement Manual Part 2, Chapter 47 (Form CMS-1728-20): https://www.cms.gov/files/document/r7p247i.pdf
