Embed Size (px)
Citation preview
NMP PROFESSIONAL SERVICES, INC Certified Public Accounting Firm
Phone: 786-372-1155 Fax: 786-558-8461 Email: [email protected]
Facility Name
Contact Name
Facility Address
City, State, Zip
Office Phone Office Fax
Provider Number Tax ID/EIN
Cost Report Period From To
Date Certified CMS Intermediary: PALMETTO NGS
E-Mail (Print)
CGS
Medicare Revenues Reported in form 1099 for the reporting period
NMP PROFESSIONAL SERVICES, INC Certified Public Accounting Firm
Phone: 786-372-1155 Fax: 786-558-8461 Email: [email protected]
1. If you prefer yourself to electronically submit your cost report to CMS please add a checkmark here. Whenyour cost report is ready, the cost report files and instructions on how to electronically submit your cost reportwill be sent by email. A copy of the cost report, financial statements, and budgets will be sent for your records.2. If you prefer that we electronically submit your cost report to CMS please add a checkmark here. andwrite below the CMS Portal (https://portal.cms.gov/) user ID and Password necessary to submit your cost reportto CMS. A copy of the cost report, e-file confirmation, financial statements and budgets will be sent for your records.
CMS Portal ID:__________________________ Password: ___________________________
3. If you prefer that we send your cost report by USPS priority mail with confirmation of delivery please add a checkmark here. The USPS tracking number will be sent to your email. A copy of the cost report, financial statements and budgets will be sent for your records. Please note that sending the cost report by mail takes longer to process and increases the risk of being rejected due to improper handling of the CD containing the cost report files, therefore, we recommend to send your cost report electronically via MCReF.
After completing the information above please send it by fax or email, we will reply as soon as possible with the price, and the required documents to prepare your facility Medicare cost report.
If you prefer to request our prices by phone please call our number below.
For Medicare Cost Report Preparation; please complete the table and select one of the options below:
