Home Health cost reports
Medicare cost reports for freestanding home health agencies, from trial balance to MCReF.
Who files
Every Medicare-participating home health agency has to submit cost data annually. Freestanding HHAs file Form CMS-1728-20. An HHA that is part of a hospital complex reports on the hospital’s CMS-2552, and one that is part of a SNF complex reports on the CMS-2540.
Current form and instructions
The CMS-1728-20 instructions apply to cost reporting periods beginning on or after January 1, 2020 (and ending on or after December 31, 2020). Transmittal 7, dated May 29, 2026, updates the instructions and electronic specifications for periods ending on or after June 30, 2026, including a new “Paid Claims Verified Current As Of” date for the PS&R questions on Worksheet S-2, Part II.
What’s in the report
A plain-English map of the main worksheets.
| Worksheets | What they cover |
|---|---|
| Worksheet S series | Certification and settlement summary, provider identification, the reimbursement questionnaire (S-2, Part II), and statistics: visits and census by discipline and payer, FTEs, CBSAs served, PPS activity, and direct care wages. |
| Worksheets A, A-6, A-8, A-8-1 | Your working trial balance of expenses, reclassifications, adjustments for non-allowable items, and costs from related organizations and home offices. |
| Worksheets B and B-1 | The step-down that allocates overhead (capital, plant, transportation, administrative and general, and so on) using statistics such as square feet and accumulated cost. |
| Worksheets C and D | Cost per visit by discipline, apportionment to Medicare, and the settlement: PPS payments, outliers, bad debts, sequestration, and interim payments. |
| Worksheets F and F-1 | Balance sheet and statement of revenues and expenses, consistent with your financial statements. |
| Worksheets O series | Only if the agency operates an HHA-based hospice. |
Where home health agencies get tripped up
Low or no Medicare utilization
Worksheet S asks whether the report is full (F), low utilization (L), or no utilization (N). A low-utilization report requires your MAC’s approval in advance. If the agency furnished no covered Medicare services all year, it still files: a signed statement plus the certification page, within 150 days of year-end.
PS&R reconciliation
Worksheet S-2, Part II asks whether the report was prepared from the PS&R alone or from the PS&R plus your records, and requires a crosswalk and documentation for adjustments such as unbilled claims. If the MAC finds the documentation insufficient, it uses the PS&R in its entirety.
Related parties and home office
Costs from related organizations are allowable at the related party’s cost, not above the price of comparable services. They’re reported on Worksheet A-8-1.
Deadlines and consequences
- Due on or before the last day of the fifth month after your cost reporting period closes, or 150 days after period end if it ends mid-month.
- A cost report is also due for a short period ending on a termination or change of ownership.
- Extensions only for extraordinary circumstances beyond your control, such as flood or fire.
- Late or unacceptable: Medicare payments are suspended immediately until an acceptable report is filed.
After you file
- Your MAC decides within 30 days whether the report is acceptable. A rejected report is treated as never filed.
- Accepted reports are desk reviewed and may be audited, then settled with a Notice of Program Reimbursement.
- Filed reports enter CMS’s Healthcare Cost Report Information System (HCRIS), which CMS publishes as public data.
How we help home health agencies
- Confirm whether you need a full, low-utilization, or no-utilization report, and request MAC approval where it’s required
- Build Worksheet A from your working trial balance, with reclassifications and adjustments documented
- Reconcile statistics and payments to the PS&R and document the crosswalk
- Prepare the electronic file and support package for MCReF
- Answer MAC desk review and audit questions
When we start, we’ll send you a records list tailored to your agency. Request a consultation →
Get your next cost report on the calendar
Tell us your agency type, fiscal year end, and MAC. We’ll follow up to talk through scope, timing, and what we need from you.