222-92 RHC Transmittals
The Medicare Cost Report changes frequently. Health Financial Systems keeps users informed in several different ways; e-mails, live web-ex sessions, news blogs, user meetings and our website. This page gives information about the details of such transmittals.


222-92 Approval Letter

222-92 T-14 from CMS Website
222-92 T-12 from CMS Website
222-92 T-11 from CMS Website

RHC/FQHC Transmittal 14

The Independent Rural Health Clinic (RHC)/Freestanding Federally Qualified Health Centers (FQHC) Cost Report, Form CMS-222-92 was updated to Transmittal 14 by CMS, on February 17, 2017. Transmittal 14 is effective for cost reporting periods ending on or after December 31, 2016.

Effective for cost reporting periods beginning on or after October 1, 2014 the Form CMS-222-92 cost report is only applicable to RHC providers. FQHC providers are currently required to file the Form CMS-224-14 cost report.

T-14 Changes include:

  • On Worksheet A, expanded the instructions for Allowable and Non-Allowable GME Pass through Costs on lines 20.50 and 53.50, respectively.
  • Also on Worksheet A, added the following cost centers:
    • Line 55.50 for Chronic Care Management (CCM)
    • Line 55.60 for Telehealth

Worksheet A-2, line 8.01 was added to accommodate the application of the RCE adjustment for teaching physicians.

Worksheet B, Part II, line 14.01 was revised to eliminate the separate calculation of overhead for direct graduate medical education (GME).

Revised Worksheet C, Part II, line 15.10 for direct GME costs.

Also on Worksheet C, Part II, added line 20.99 to capture the Pioneer Accountable Care Organization (ACO) demonstration payment adjustment amount in accordance with ACA 2010, §3022.

HFS released the 222-92 T-14 software on April 6, 2017 as version number 14.1.160.0.


RHC/FQHC Transmittal 13

Transmittal 13, dated February 2017, was rescinded and replaced by Transmittal 14, dated March 2017, to change the effective date from “cost reporting periods ending on or after September 30, 2016,” to “cost reporting periods ending on or after December 31, 2016.”


RHC/FQHC Transmittal 12

The RHC/FQHC, 222-92 system was updated to Transmittal 12 by CMS, in September 2015. Transmittal 12 is effective for cost reporting periods beginning on or after October 1, 2014. The primary purpose for this transmittal is to implement edits prohibiting the use of Form 222-92 by FQHCs, for cost reporting periods beginning on or after October 1, 2014. Due to the implementation of a revised PPS effective for cost reporting periods beginning on or after October 1, 2014, CMS has proposed a new cost reporting Form CMS-224-14, for FQHC providers. The following edits have been added:

  • Level One edit 1021S – If Worksheet S, Part I, line 5, column 3, is “2” (indicating an FQHC), then Worksheet S, Part I, line 4, column 1 (cost report period begin date), cannot be on or after October 1, 2014.
  • Level one edit 1031S – For any FQHC providers filing a consolidated cost report, Worksheet S, Part III, line 6, column 2, (certification date for additional providers) cannot be after October 1, 2014.

In addition Transmittal 12, shaded the Worksheet B-1, columns 2.01 and 2.02, for H1N1 vaccines, effective for cost reporting periods beginning on or after October 1, 2014.


RHC/FQHC Transmittal 11

The RHC/FQHC, 222-92 system was updated to Transmittal 11 by CMS, in May 2013. Transmittal 11 is effective for FY overlapping 4/1/2013, for the Sequestration reduction (i.e. all FYE on or after 4/1/2013 MUST use Transmittal 11). In addition Transmittal 11 includes bad debt changes effective for FY Begin on or after 10/1/2012.

  • HFS was approved for Transmittal 11 on July 29, 2013.
  • Transmittal 11 was primarily to implement the Bad Debt reduction changes as of FY Begin 10/1/2012, and the 2% Sequestration reduction for services(FYE) on or after 4/1/2013. Sequestration will be computed as days on or after 4/1/2013 divided by total days in the FY, times 2%. Thus, a 6/30/2013 FYE would have about a half percent reduction. The Bad Debt reduction is 12% for FY Begin 10/1/2012 to 9/30/2013; 24% for FY Begin 10/1/2013 to 9/30/2014; and 35% for FY Begin 10/1/2014 and after.
  • The Sequestration reduction is computed on W/S C, line 24.11, as 2% of the sum of lines 21 and 24.10.
  • The Bad Debt reduction is computed on W/S C, line 24.10.
  • CMS clarified in T.11, the rounding standards to compute the Sequestration reduction.
  • CMS added in T.11, W/S S part I, line 8.50 to capture the Visits performed by Interns & Residents, to facilitate the calculation of GME pass through cost.
  • CMS added in T.11, W/S S part I, line 8.51 to determine if an approval was granted for an exception to the Productivity Standards.
  • CMS added in T.11, W/S A, line 20.50, to provide for allowable GME pass through cost.
  • CMS added in T.11, W/S A, line 53.50, to provide for non-allowable GME pass through cost.
  • CMS clarified in T.11, W/S B part I, column 3, Productivity Standards.
  • CMS added in T.11, W/S B part II, line 14.01, to provide for allowable GME pass through cost.
  • CMS added in T.11, W/S B part II, line 14.02, to identify net facility overhead cost.
  • CMS added in T.11, W/S C part II, line 15.10, to accommodate allowable GME pass through cost.
  • CMS added in T.11, W/S C part II, line 24.02, to accommodate Tentative Settlement.
  • CMS added in T.11, W/S C part II, line 24.10, to implement the Bad Debt reduction.
  • CMS added in T.11, W/S C part II, line 24.11, to accommodate the 2% Sequestration reduction.
  • CMS clarified in T.11, various portions of the Electronic Specifications, which are to be followed by all Vendors.