How To Complete Step 6: Manage Submission Of Final Cost Reports - New 05/10/2007
The following document refers to reconciliation and provides questions and answers regarding Step 6. This section contains information about who may complete the step, when and how the step should be completed and other information related to reconciliation. This document includes information about the following:
- What is the purpose of Step 6: Manage Submission of Final Cost Reports?
- When can Plan Sponsors begin Step 6: Manage Submission of Final Cost Reports?
- When can Plan Sponsors complete Step 6: Manage Submission of Final Cost Reports?
- Who is allowed to complete Step 6: Manage Submission of Final Cost Reports?
- How can I tell if Step 6: Manage Submission of Final Cost Reports has been completed?
- Can Step 6: Manage Submission of Final Cost Reports be undone after it has been completed?
- What happens after Step 6: Manage Submission of Final Cost Reports is completed?
- What must be done from an operational perspective to complete Step 6: Manage Submission of Final Cost Reports?
- Does interim cost data need to be reported again during reconciliation?
- How is final cost data entered?
- Do I need to complete the management of final cost reports all at once or can I finish it later?
- Is the mainframe cost report file layout for final cost reports different from the layout for interim cost reports?
- How will CMS' RDS Center know that a Plan Sponsor is submitting final, rather than interim cost reports?
- What does "Status of Last Report" on the Benefit Option List page mean and what are the different statuses that could be presented here?
- How does a Plan Sponsor complete Step 6: Manage Submission of Final Cost Reports?
What is the purpose of Step 6: Manage Submission of Final Cost Reports?
The purpose of this step is to allow the Account Manager or Designee with the Request Payment privilege to monitor submission of final cost reports and all reporting sources for the entire application. If the Account Manager has the Report Costs privilege for this application they will able to enter final cost reports for the assigned benefit options. By completing Step 6, the user can specify that final cost reporting is complete for this application, disallowing any further final cost reports. The user may return to this step at a later time to allow additional cost reporting if necessary.
When can Plan Sponsors begin Step 6: Manage Submission of Final Cost Reports?
Step 6 cannot be started until Step 1 though Step 5 has been completed. Step 6 must be marked "Complete" on the Reconciliation Checklist to proceed to the remaining steps.
When can Plan Sponsors complete Step 6: Manage Submission of Final Cost Reports?
Plan Sponsors may complete Step 6 when at least one final cost report has been submitted for each benefit option for which the Plan Sponsor received an interim payment, and no final cost report is currently in "Data Entry: Saved" status.
Who is allowed to complete Step 6: Manage Submission of Final Cost Reports?
Step 6 can only be completed by the Account Manager and Designees with the Request Payment privilege. The Authorized Representative will have View Only access to this page. Final cost reports should be reviewed to ensure final cost reporting is complete and accurate. If the Account Manager has the Report Costs privilege for this application they will be able to enter final cost reports for the assigned benefit options. The user can specify that final cost reporting is complete for this application, disallowing any further final cost reports. The completion of this step should be carefully coordinated if there are multiple cost reporters associated with the application.
How can I tell if Step 6: Manage Submission of Final Cost Reports has been completed?
The Reconciliation Checklist displays as follows:
- Step 6 is marked with a green check to indicate that the step is complete and Step 7 is marked with a blue arrow to indicate that it is the next step.
- The status of Step 6 will be marked "Complete" on the Reconciliation Checklist.
- The Last Updated Date and Last Updated By fields are updated accordingly.
- The status of the application will change to "Reconciliation Cost Reporting Closed."
Can Step 6: Manage Submission of Final Cost Reports be undone after it has been completed?
Yes. The option to allow final cost reporting after previously completing Step 6 is available until Step 12 has been completed. Step 7 through Step 11 will be marked "Incomplete" as a result of choosing to allow final cost reporting again, even if they were previously marked "Complete."
What happens after Step 6: Manage Submission of Final Cost Reports is completed?
After Step 6 is completed:
- Data entry final cost reports can no longer be entered and/or edited on the RDS Secure Web Site.
- Mainframe final cost reports that are submitted will be rejected and will appear in the audit trail with a status of "Mainframe: Errors Detected."
- The application status will be "Reconciliation Cost Reporting Closed" until the final reconciliation payment request is submitted.
What must be done from an operational perspective to complete Step 6: Manage Submission of Final Cost Reports?
The Plan Sponsor should be aware of the status of cost reporting from all Cost Reporters assigned to the application. If cost reports are expected from Vendors using mainframe submission, the Plan Sponsor should get the expected delivery date for the final cost file submission from their Vendors. The Plan Sponsor should check to ensure that this file was received and accepted. Mainframe cost reports are rejected if any of the data consistency or reasonableness edits fail. In this situation, the status of the mainframe cost report will be "Errors Detected." The Plan Sponsor should be working with the Vendor to eliminate the error conditions. If cost reports are expected to be entered using Data Entry, the Plan Sponsor should be monitoring the status of each cost report to ensure that no part of the cost report is left in "Data Entry: Saved" status because that is an indication that cost reporting is not yet complete from that Cost Reporter.
It is expected that the Plan Sponsor will have internal supporting drug cost details and summarized data that validates all final cost data being reported. Furthermore, it is expected that the Plan Sponsor will compare the summarized data with the final cost reports that have been submitted to ensure that the final cost data that could be included in the reconciliation payment request are accurate. Accurate cost reports are those that:
- Include only allowable cost data incurred during a subsidy period for the qualified covered retirees
- Have been accurately adjusted to account for coordination of individual retiree cost data. For additional information, go to: Coordination of Individual Retiree Costs
- Have accurately extracted cost data for drugs that are not eligible for Medicare Part D
- Have accurately completed all financial accounting for beneficiary costs and actual cost adjustments (e.g., discounts, chargebacks, rebates, and similar price concessions) for this application
For more information about what a Plan Sponsor should consider while monitoring and managing final cost reporting, go to: Reconciliation: What Plan Sponsors Need to Know Before Getting Started and the: Reconciliation Job Aid.
Does interim cost data need to be reported again during reconciliation?
No. Only final cost data may be reported for reconciliation.
If interim cost data were reported using data entry and:
- Gross retiree cost data were reported as interim cost data on the RDS Secure Web Site, the last reported interim cost data will display as final cost data with a status of "Data Entry: Update/Entry Required." A Cost Reporter must update cost data to reflect final reported cost data if necessary and save all previously reported months.
- Estimated premiums were reported as interim cost reports, no previously reported cost data will display. Cost data must be entered and saved for all months in the plan year.
OR
Note: Cost data must be reported for all months in order to submit a final cost report. Zero dollars are accepted.
If interim cost data were reported using mainframe submission, all final cost data must be submitted for all months within the application plan year.
How is final cost data entered?
Account Managers assigned the data entry reporting method may enter final cost data by selecting either the "Enter/Update Costs" action within Step 6 of the Reconciliation Checklist or the Final Costs action on the Application List page for the assigned benefit options. Designee Cost Reporters assigned the data entry reporting method may enter cost data by selecting the Final Costs action on the Application List page. Mainframe final cost reports may be submitted using the same methodology as interim cost reports. Individual Vendor Cost Reporters or the Plan Sponsor may view submitted cost reports by accessing the Final Costs action on the Application List page for the assigned benefit options. For more information, go to: How to Submit Final Cost Data.
Do I need to complete the management of final cost reports all at once or can I finish it later?
Account Managers and Designees with the Request Payment privilege will be permitted to return to Step 6 as often as needed to manage the submission of final cost reports.
Is the mainframe cost report file layout for final cost reports different from the layout for interim cost reports?
No. The mainframe final cost reports will be accepted in the same format as interim cost reports. The final cost data may be reported in a batch file that may also include interim cost data for other applications.
The difference between interim cost reports and final cost reports include the following:
- All plan months must be reported for the final cost report to be accepted by CMS' RDS Center.
- The final cost report may not include estimated premiums. Gross retiree cost data must be submitted as final cost data.
- Plan Sponsors must report actual cost adjustments when submitting final cost data for reconciliation rather than reporting estimated cost adjustments submitted for interim cost reporting. The actual cost adjustment is reported in the same field as estimated cost adjustment.
- The status of the application must be "Reconciliation: Cost Reporting Opened" for a final cost report to be accepted by CMS' RDS Center.
- Only zero cost data can be reported for benefit options without eligible retirees.
How will CMS' RDS Center know that a Plan Sponsor is submitting final, rather than interim cost reports?
CMS' RDS Center will distinguish interim cost reports from final cost reports based on the status of the application. After Step 1 is completed, changing the application status to "Reconciliation Initiated," all submitted cost reports will be considered final cost reports. Final cost reports will not be accepted until Step 5 is completed and the application status is "Reconciliation Cost Reporting Opened."
What does "Status of Last Report" on the Benefit Option List page mean and what are the different statuses that could be presented here?
Valid statuses are:
- Data Entry: Saved - This status pertains only to cost reports received using data entry and indicates that the last final cost report was saved but not yet submitted for this reporting source.
- Data Entry: Entry/Update Required - This status pertains only to cost reports received using data entry and indicates that there is at least one month of the cost report that has not been updated to reflect final cost data for this reporting source.
- Data Entry: Submitted – This status pertains only to cost reports received using data entry and indicates that the final cost report for this reporting source has been submitted and is now available for inclusion in the reconciliation payment request.
- Mainframe: Submitted – This status pertains only to cost reports received using mainframe file transfer and indicates that no errors were detected and that the final cost report for this reporting source is now available for inclusion in the reconciliation payment request.
- Mainframe: Errors Detected – This status pertains only to cost reports received using mainframe file transfer and indicates that at least one error was detected in the last submitted report from this reporting source.
- No Reports – No cost reports have yet to be processed (mainframe) or saved/submitted (data entry) for this reporting source.
- No Final Reports – This status pertains only to cost reports received using mainframe file transfer and indicates that interim cost reports have been received from this reporting source, however no final cost reports have been received from this reporting source.
How does a Plan Sponsor complete Step 6: Manage Submission of Final Cost Reports?
- Log into the RDS Secure Web Site.
- The Plan Sponsor List With Application Summary page displays.
- Select the appropriate Plan Sponsor ID link. The Application List page displays.
- From the Application List page, find the Application Number to reconcile. To access reconciliation, select Reconciliation from the Actions dropdown and select Go.
- The Reconciliation Checklist page displays. Select Step 6: Manage Submission of Final Cost Reports.
- The Step 6: Manage Submission of Final Cost Reports page displays.
- The Benefit Option List table on this page contains a row for each cost reporting source for each benefit option for this application. For each benefit option, the View Cost Summary (see instruction a.), Enter/Update Costs (see instruction b.), or View Audit Trail (see instruction c.) actions are available according to the user's privileges and status of cost reports available.
- Select the View Cost Summary action to display the Benefit Option Final Cost Summary page.
- Select the Enter/Update Costs action to display the Benefit Option Final Cost Data Entry View page.
- This page contains the Monthly Benefit Option Cost Data table. To edit cost data for each month, select the edit link.
- The Benefit Option Cost Data Entry Edit page displays. The following fields may be edited:
- Gross Retiree Cost
- Threshold Reduction
- Limit Reduction
- Actual Cost Adjustment
To save any changes, select Save or to continue without saving changes, select Cancel.
- The Benefit Option Cost Data Entry Edit page displays. The following fields may be edited:
- This page contains the Monthly Benefit Option Cost Data table. To edit cost data for each month, select the edit link.
- Select the View Audit Trail action to display the Audit Trail of Benefit Option Cost Reports page.
- Select Complete Reporting, or if this step has been previously completed and needs to allow reporting, select Allow Reporting.
- The Step 6: Manage Submission of Final Cost Reports Complete Verification page displays. To confirm that reporting is complete, select Confirm. To return to Step 6, select Cancel.
- The Step 6: Manage Submission of Final Cost Reports Complete Confirmation page displays. To proceed to the Reconciliation Checklist, select Continue.
- The Reconciliation Checklist displays. The status of Step 6: Manage Submission of Final Cost Reports changes to "Complete" and the Last Updated Date and Last Updated By fields are updated accordingly. Step 6 is marked with a green check to indicate that the step is complete and Step 7 is marked with a blue arrow to indicate that it is the next step.
