Reliable Cost Report Preparation
National Cost Report NCR .
Phone:
832-237-1040
8555 Westland West Blvd .
Fax:
832-237-1042
Houston, TX 77041.

Please Print, Complete and Fax to: 1-832-237-1042

Date:
Contact Name:
Contact Phone Number:
Contact Fax number:
Company name:
Street Address:
City:
State:
Zip:
 
Provider Number
Facility Name
Beginning Cost
Report Period Date
Ending Cost
Report Period Date
       
       
       
       
       
       
       
       
This includes:
Preparation of your fiscal year end Hospice cost report as required by CMS and your fiscal intermediary. Each Medicare cost report will be completed in compliance with CMS HIM-15 and chapter 38 rules and regulations including submission of the CMS-339 questionnaire and a diskette containing the Medicare cost report ECR files. This service also includes answering of desk review and field audit questions as they relate to the cost report preparation for a period not less than twelve months from the date of cost report submission.
 
Upon receipt of this order form, we will contact you to establish communication, assess your needs, due dates, any special circumstances. We will determine a fee for cost report preparation and prepare a cost report preparation engagement bid for your review and approval.
 
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