Rural Health Clinic (RHC) Cost Report — CMS-222-17

By costreporting.aiPublished May 26, 2026

The Rural Health Clinic cost report is the annual Medicare filing every independent (freestanding) Medicare-certified RHC submits to its MAC on Form CMS-222-17, reconciling the clinic's allowable cost of treating Medicare beneficiaries against the all-inclusive rate (AIR) per-encounter interim payments received during its fiscal year (42 CFR § 413.20). Provider-based RHCs report their RHC activity on the parent provider's cost report instead.

What the CMS-222-17 covers

The CMS-222-17 walks the clinic's finances from raw trial balance to Medicare settlement. The cost report captures direct cost by cost center, allocates overhead across patient-care services, and computes the cost-per-visit. The per-visit cost is compared to the statutory AIR upper payment limit and the productivity-adjusted cost; payment is the lesser. The productivity standard is 4,200 visits per FTE physician and 2,100 visits per FTE nurse practitioner / physician assistant / certified nurse-midwife unless the MAC accepts a documented deviation.

RHC 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. RHC (CMS-222-17) is on the post-pilot roadmap. Join the waitlist below if you'd like notification when RHC support ships.

The 42 CFR § 413.24 cost-finding standard applies regardless of provider type, so the architectural principle (AI classifies, determinism calculates, every customer-visible number traces to an audit-trail entry) carries forward when RHC support lands. Whether you use a CPA firm, a billing agency, or an independent consultant for filing today, the documentation standard is the same, and your authorized representative signs the cost report regardless of preparer.

Common questions

What form is the RHC cost report filed on?

Independent (freestanding) Medicare-certified Rural Health Clinics file Form CMS-222-17. Provider-based RHCs (those owned by a hospital, SNF, or home health agency) report their RHC activity on the parent provider's cost report (typically CMS-2552-10 for hospital-based RHCs) rather than filing CMS-222-17 separately.

When is the RHC cost report due?

Five months after the end of the clinic'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-222-17 calculate?

The CMS-222-17 captures the clinic's trial balance, allocates direct and indirect cost across cost centers, and computes a per-visit cost. Independent RHCs are paid an all-inclusive rate (AIR) per encounter subject to the statutory upper payment limit and the productivity standard (typically 4,200 visits per FTE physician and 2,100 per FTE NP/PA). The cost report reconciles the clinic's allowable cost-per-visit against the AIR payments received during the year.

How is RHC payment different from FQHC payment?

Both are visit-based, but the mechanisms differ. RHCs are paid an all-inclusive rate (AIR) per Medicare visit, subject to the per-visit upper payment limit and the productivity standard. FQHCs are paid under the FQHC Prospective Payment System (PPS) at 42 CFR Part 405 Subpart X using a single PPS rate (adjusted for geography and visit type) per encounter. The cost-report worksheets and reconciliation logic are distinct.

Does costreporting.ai support RHC cost reports today?

Not yet. The pilot product currently supports HHA (CMS-1728-20) and Hospice (CMS-1984-14) for the November 2026 cohort. RHC support is on the roadmap for the post-pilot release. If you operate an independent RHC and want to be notified when CMS-222-17 support ships, join the waitlist below.