No Medicare Utilization

Waiver of electronic filing

HCL’s that have not provided any services to Medicare beneficiaries during the cost reporting period are eligible to file a ‘No Medicare Utilization cost report.”
Facilities that have provided Lab services to Medicare beneficiaries but have not yet been reimbursed for those services, will not meet the requirements to file a no utilization cost report.
A “no Medicare utilization” cost report is an abbreviated cost report (only complete Form 216-94, Worksheet S and the Form CMS 339 Questionnaire). This report is not filed electronically.
To file a “no Medicare utilization cost report” you must request a waiver of the requirement to file electronically.
The provider must submit a written request for a waiver with necessary supporting documentation to Riverbend no later than 30 days after the end of its cost reporting period.
The intermediary reviews the request, and if the provider meets the criteria, the fiscal intermediary is authorized to approve the request directly within 30 days of receipt of the request.
Requests to file a no utilization cost report should be submitted to:
          Kelly Scoggins, Audit Manager
          Riverbend Government Benefits Administrator
          730 Chestnut Street
          Chattanooga, TN 37402
If you have questions related to the electronic filing of your cost report, please contact and auditor or supervisor on the organization chart.

Riverbend