Cost Report Worksheets Explained (S / A / B / C / D)
By costreporting.aiPublished
A Medicare cost report worksheet is one form in the linked set that together computes a provider's Medicare settlement. Each worksheet feeds the next: totals carry forward, and the set must reconcile end-to-end before the Medicare Administrative Contractor (MAC) will accept the report (42 CFR § 413.24).
The worksheet chain
- Worksheet S — certification and provider statistics: who is filing, the fiscal year, and the statistical bases (visits, patient days, FTEs) that drive the step-down.
- Worksheet A — the trial balance of expenses: each general-ledger account is classified to a CMS cost center, producing direct cost by center.
- Worksheet B — the step-down: general & administrative, plant, and capital overhead are allocated onto the patient-care cost centers using the Worksheet S statistics as the basis.
- Worksheet C — cost-to-charge ratios and apportionment: the share of cost attributable to Medicare.
- Worksheet D / G / H — settlement: the Medicare-allowable amount versus interim payments, producing the amount owed to or by the provider.
Why reconciliation is the hard part
The worksheets are not independent forms — Worksheet A's grand total must equal the post-step-down total on Worksheet B (mass conservation), and downstream totals must tie to it. A report whose worksheets do not reconcile is rejected, restarting the review clock. costreporting.ai classifies the trial balance, runs the step-down deterministically, and reconciles cross-worksheet before you ever see the draft — every figure traced to its formula and inputs.