Hospital Cost Report — CMS-2552-10

By costreporting.aiPublished May 26, 2026

The Medicare hospital cost report is the annual filing every Medicare-certified hospital submits to its MAC on Form CMS-2552-10, reconciling the hospital's allowable cost of treating Medicare beneficiaries against the IPPS, OPPS, and PPS-exempt payments received during its fiscal year (42 CFR § 413.20). It is the most worksheet-complex form in the Medicare cost-report family — covering inpatient, outpatient, GME, IME, DSH, and S-10 uncompensated-care reporting on a single annual submission.

What the CMS-2552-10 covers

The CMS-2552-10 walks the hospital's finances from trial balance through cost finding to Medicare settlement. Worksheet A captures direct cost by cost center across roughly 100 potential cost-center lines. Worksheet B performs the step-down — administrative and general, plant operations, maintenance, and capital overhead are allocated to the patient-care cost centers. Worksheet C applies cost-to-charge ratios; Worksheet D / D-1 / D-2 computes inpatient routine and ancillary settlement; Worksheet E computes outpatient settlement; Worksheet S-10 captures uncompensated-care data for the DSH adjustment; and additional worksheets handle GME, IME, and bad-debt reimbursement.

Hospital 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. Hospital (CMS-2552-10) is on the post-pilot roadmap, with the worksheet complexity informing the build order. Join the waitlist below if you'd like notification when hospital support ships.

The architectural principle (AI classifies, determinism calculates, every customer-visible number traces to an audit-trail entry) is form-agnostic and carries forward when hospital support lands. 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 applies regardless of preparer or provider type, and your authorized representative signs the cost report.

Common questions

What form is the hospital cost report filed on?

Medicare-certified short-term acute-care hospitals, long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, critical access hospitals, and children's hospitals all file Form CMS-2552-10. It is the most complex of the CMS cost-report forms — multiple cost-center categories, ancillary apportionment, and a Worksheet S-10 that captures uncompensated-care data feeding the Medicare DSH adjustment.

When is the hospital cost report due?

Five months after the end of the hospital's fiscal year, per 42 CFR § 413.24(f)(2). A June 30 year-end means a November 30 due date. The MAC may grant a limited extension only for good cause beyond the provider's control.

What is Worksheet S-10 and why does it matter?

Worksheet S-10 captures uncompensated-care data — charity care + non-Medicare bad debt — that feeds the Medicare Disproportionate Share Hospital (DSH) adjustment under 42 CFR § 412.106. The Factor 3 calculation in the IPPS rule uses S-10 data nationwide to redistribute the uncompensated-care DSH pool, so S-10 accuracy directly affects DSH payment. It is the worksheet most frequently audited and most consequential to settlement variance.

Does costreporting.ai support hospital cost reports today?

Not yet. The pilot product currently supports HHA (CMS-1728-20) and Hospice (CMS-1984-14) for the November 2026 cohort. Hospital (CMS-2552-10) is on the post-pilot roadmap — it is the most worksheet-complex form on the platform's plan, so we're shipping the smaller-surface forms first to validate the architectural principles. Join the waitlist below for hospital support notifications.