Federally Qualified Health Center (FQHC) Cost Report — CMS-224-14
By costreporting.aiPublished
The FQHC cost report is the annual Medicare filing every Medicare-certified Federally Qualified Health Center submits to its MAC on Form CMS-224-14, reconciling the center's allowable cost of treating Medicare beneficiaries against the FQHC PPS interim payments received during its fiscal year (42 CFR § 413.20). The FQHC PPS rate is set under 42 CFR Part 405 Subpart X with annual updates.
What the CMS-224-14 covers
The CMS-224-14 walks the FQHC's finances from trial balance through cost finding to Medicare settlement. Worksheet A captures direct cost by cost center across the FQHC's service categories. Worksheet B performs the step-down apportioning administrative + general and facility overhead to the FQHC service cost centers. Worksheet C computes per-visit cost using allowable cost divided by allowable visits. Worksheet D performs the PPS reconciliation — actual visits times the applicable PPS rate (with locality and provider-type modifiers) against allowable cost — to produce the year-end settlement.
FQHC support: pilot status + roadmap
costreporting.ai currently supports HHA (CMS-1728-20) and Hospice (CMS-1984-14) for the November 2026 pilot cohort. We're building the platform deliberately one form at a time — the deterministic engine, audit-trail, and cost-finding methodology must be exactly right for each form's worksheet structure before we add the next. FQHC (CMS-224-14) is on the post-pilot roadmap. Join the waitlist below if you'd like notification when FQHC support ships.
Whether you use a CPA firm, a billing agency, or an independent consultant for filing today, the 42 CFR § 413.24 cost-finding documentation standard is the same. The platform's architectural principle (AI classifies, determinism calculates, every customer-visible number traces to an audit-trail entry) carries forward when FQHC support lands. Your authorized representative signs the cost report regardless of preparer.
Common questions
What form is the FQHC cost report filed on?
Medicare-certified Federally Qualified Health Centers file Form CMS-224-14. It replaced the older CMS-222 series for FQHCs operating under the FQHC PPS payment system (effective Oct 1, 2014). The form captures cost, visits, and the reconciliation between FQHC PPS interim payments and allowable cost.
When is the FQHC cost report due?
Five months after the end of the FQHC's fiscal year, per 42 CFR § 413.24(f)(2). The MAC may grant a limited extension only for good cause beyond the provider's control. The deadline is the same five-month rule that applies to other Medicare cost-report filers.
What does the CMS-224-14 calculate?
It captures the FQHC's trial balance, allocates direct and indirect cost across cost centers (administrative & general, facility, FQHC service), computes per-visit cost using the step-down methodology under PRM Pub. 15-1 Chapter 23, and reconciles the FQHC PPS interim payments against allowable cost to produce the year-end settlement variance. The PPS rate is set nationally with locality adjustments; the cost report does not change the rate but does reconcile actual visits + actual cost against the rate-times-visits payment.
Does costreporting.ai support FQHC cost reports today?
Not yet. The pilot product currently supports HHA (CMS-1728-20) and Hospice (CMS-1984-14) for the November 2026 cohort. FQHC (CMS-224-14) is on the post-pilot roadmap. The cost-finding methodology under 42 CFR § 413.24 is provider-type-agnostic, so the platform's architectural principle (AI classifies, determinism calculates) carries forward to FQHC when support ships. Join the waitlist below for FQHC notifications.
Sources
- Regulation:42 CFR § 413.20 — Financial data and reports
- Regulation:42 CFR § 413.24 — Adequate cost data and cost finding (filing at § 413.24(f))
- Regulation:42 CFR Part 405 Subpart X — Rural Health Clinic and Federally Qualified Health Center Services
- CMS Manual:Provider Reimbursement Manual, Part 2 (Pub. 15-2) — CMS-224-14 FQHC cost report instructions