Get Started

RDS Program Components

Additional Program Tasks

Quick Access Reports (QAR)

Supplemental Information

Step 7: Review Final Costs

User Roles:

AM

D

Program Components:

Reconciliation

Overview

This section provides an overview of the following topics related to completing Step 7: Review Final Costs:

Introduction to Step 7: Review Final Costs

The purpose of Step 7: Review Final Costs is for the Account Manager or Designee with Request Payment privilege to review and confirm all final cost reports for the application after final cost reporting is closed in Step 6: Manage Submission of Final Cost Reports. System edits examine the Allowable Retiree Costs and Threshold Reductions for the entire application and each Benefit Option. Edits are applied to all final cost reports submitted in Step 6 that have not been rejected by CMS' RDS Center or the Plan Sponsor. The Plan Sponsor must resolve any errors detected in Step 7 by either rejecting specific cost reports until errors are resolved or reopening Step 6 to allow Cost Reporters to resubmit costs.

The Plan Sponsor may review costs reported for a Benefit Option by Cost Reporter and plan month by selecting the Review Costs Action on the Step 7: Review Final Costs main page. Unlike an interim payment request, the Plan Sponsor may exclude individual cost reports from the final Reconciliation payment request by "Rejecting" the report. The Plan Sponsor may save the current status of their cost review and return to Step 7 at a later time to complete.

When the Plan Sponsor is satisfied with the accepted costs for a Benefit Option and the resulting Current Subsidy Amount, they must indicate acceptance of the Benefit Option costs by completing the Benefit Option review. When the review is complete for all Benefit Options, "Review Complete" becomes enabled allowing the Plan Sponsor to complete Step 7.

Return to top

Timing for Step 7: Review Final Costs

Step 7: Review Final Costs cannot be started until Steps 1 through 6 have been completed. Step 7 must be marked "Complete" on the Reconciliation Checklist to proceed to the remaining steps. Prior to the completion of Step 12: Review and Submit Reconciliation Payment Request, the Plan Sponsor may return to Step 7 to reopen their cost review. A Plan Sponsor may also revisit Step 7 as often as necessary to view costs included in the final Reconciliation payment request.

Return to top

User Role Responsibilities for Step 7: Review Final Costs

Step 7: Review Final Costs can only be completed by the Account Manager or Designee with Request Payment privilege. The Authorized Representative has "View Only" access to this step.

Return to top

Reviewing Costs in Step 7

To ensure a successful review of final cost reports, Plan Sponsors should consider the following:

Status of Benefit Option Costs

  • "As Reported" or "No Reports" - Initially all Benefit Options in Step 7: Review Final Costs display this status
  • "No Reports" - No final cost reports for the Benefit Option were accepted by CMS' RDS Center
  • "As Reported" - All final cost data reported for the Benefit Option during final cost reporting are included in the Benefit Option Current Subsidy calculation and are included in the final Reconciliation payment request
  • "All Reports Rejected" or "Some Reports Rejected" - Cost reports are rejected by the Plan Sponsor

Viewing Benefit Option Costs and Individual Cost Reports

The Plan Sponsor can view costs currently included in the Reconciliation payment request any time after Step 6: Manage Submission of Final Cost Reports is complete. The Plan Sponsor can select the "Review Costs" action for a Benefit Option to view both accepted and rejected cost reports, a Plan Year Benefit Option Summary, and a Monthly Plan Year Benefit Option Summary.

Error Conditions

After cost reporting is closed, the system applies edits to the total costs accepted for the application by examining the Allowable Retiree Costs, Threshold Reduction, and unique count of Qualifying Covered Retirees (QCRs) for the entire application. These edits assure that the maximum Allowable Retiree Cost and Threshold Reduction have not been exceeded per individual QCR as a result of insufficient coordination of individual retiree costs.

Similar to Step 6: Manage Submission of Final Cost Reports, the system once again examines the accepted costs for each Benefit Option. In Step 6, warnings are given if the maximum Allowable Retiree Costs and Threshold Reduction are exceeded as a result of multiple cost reporting sources submitting duplicate costs or not properly coordinating individual retiree costs. In Step 7: Review Final Costs, this condition results in an error.

Note: A Plan Sponsor is unable to complete Step 7 until all error conditions are resolved.

Application Level Errors

For each error detected in the combined application costs, a detailed error message appears at the top of the Step 7: Review Final Costs page. "Complete Review" is also disabled. The Plan Sponsor may view the accepted costs for each Benefit Option in detail by selecting the "Review Costs" action on the Step 7 page.

Benefit Option Level Errors

Should one or more errors be detected in Benefit Option costs, an error message appears in red at the top of the Step 7: Review Final Costs page and an "!" icon appears in the Warnings/Errors column for the appropriate Benefit Options. The "Review Complete" checkbox for the Benefit Option appears unchecked and disabled. "Complete Review" is also disabled.

The Plan Sponsor must select the "Review Costs" action for the Benefit Option to view detailed error messages on the Benefit Option Cost Review page. An error message displays for each error detected in Benefit Option costs.

Resolving Error Conditions

All cost reports rejected in Step 7: Review Final Costs are excluded from further cost editing. If an error condition was caused by duplicate reporting, the Plan Sponsor may choose to reject one or more individual cost reports to resolve the error condition. If the error was caused by the reporting of inaccurate final costs, the Plan Sponsor must reopen final cost reporting and re-submit accurate final costs.

Warning Conditions

The warnings that appear in Step 7 inform the Plan Sponsor of new or unusual conditions that could affect their cost review. When a warning is detected a warning message appears at the top of the page and an "!" icon appears in the Warnings/Errors column for the appropriate Benefit Option. Warnings alert the Plan Sponsor to such conditions as the potential for duplicating costs and newly submitted cost reports. Possible courses of action are suggested in the warning. Warnings do not prevent the Plan Sponsor from continuing their review of costs in Step 7: Review Final Costs.

Multiple Cost Reporting Sources

If multiple sources successfully reported final costs during final cost reporting, the costs reports are initially summed in Step 7: Review Final Costs to calculate the final costs for the Benefit Option. A warning appears at the top of the page informing the Plan Sponsor that final costs have been accepted from Multiple Reporting Sources and the Unique Benefit Option Identifier (UBOI) is listed in the warning text. In Step 7, the Plan Sponsor has the ability to reject a cost report from a specific source. When the cost report is rejected, it is excluded from the Benefit Option figures and the final Reconciliation payment request.

Note: The Number of Reporting Sources listed for the Benefit Option indicates how many reporting sources are set up to report final costs in Step 2: Review Payment Setup, not how many sources actually reported final costs.

Rejecting a Cost Report

If only one source successfully reported costs for the Benefit Option, the Plan Sponsor may reject the final cost report by first selecting the "Review Costs" action on the Step 7: Review Final Costs page and then selecting "Reject" on the Benefit Option Cost Review page. The Plan Sponsor is returned to the Step 7: Review Final Costs page. The status of the Benefit Option appears as "All Reports Rejected" and the Current Subsidy Amount indicates zero final costs. The rejected costs are excluded from the Current Costs reflected in the Step 7: Review Final Costs table.

If more than one source successfully reported costs for the Benefit Option, the Plan Sponsor may reject a final cost report by first selecting the "Review/Reject Costs" action on the Benefit Option Cost Review page and then selecting "Reject" on the Benefit Option Final Cost Report page. The Plan Sponsor is returned to the Step 7: Review Final Costs page. The status of the Benefit Option appears as "Some Reports Rejected" and the Current Subsidy Amount is recalculated to exclude the rejected costs. If the Old Subsidy Amount now exceeds the Current Subsidy Amount, the Net Subsidy Amount appears as a negative number. The rejected costs are excluded from the Current Costs reflected in the Step 7: Review Final Costs table.

Upon returning to the Benefit Option Cost Review page, "Rejected" appears as the status for the Cost Reporting Source.

Note: If an interim subsidy was received for the Benefit Option, the Plan Sponsor is not permitted to complete Step 7 if all costs are rejected for the Benefit Option. The Plan Sponsor receives an error message after selecting "Complete Review."

The Plan Sponsor is not permitted to complete Step 7 if all cost reports are rejected for the application.

Undo the Rejection of a Cost Report

To once again include a cost report in the Reconciliation payment request, the Plan Sponsor may choose to "Undo" the previous rejection of a cost report. The Plan Sponsor may select "Undo Reject" on the Benefit Option Review page if only one source reported final costs and on the Benefit Option Final Cost Report page if multiple sources reported final costs. The Plan Sponsor is returned to the Step 7: Review Final Costs page where the previously rejected costs are reflected in the Current Subsidy Amount figures for the Benefit Option and the Current Costs in the Step 7: Review Final Costs table.

Upon returning to the Benefit Option Cost Review page, "As Reported" appears as the status for the Cost Reporting Source.

Reopening Cost Reporting

If inaccurate or incomplete final costs are detected during the review of costs, the Plan Sponsor must reopen final cost reporting by returning to Step 6: Manage Submission of Final Cost Reports. Reopening Step 6 causes the status of Step 7: Review Final Costs to return to an "Incomplete" status but any completed Benefit Option Reviews remain checked until final costs are re-submitted for the Benefit Option.

Completing the Review of Costs for a Benefit Option

The "Review Complete" checkbox becomes enabled for a Benefit Option that has reported final costs when no errors are detected for the Benefit Option or all error conditions relating to the Benefit Option are resolved. The "Review Complete" checkbox must be checked for all Benefit Options to enable "Complete Review."

Completing Step 7

The Plan Sponsor must select "Complete Review" to complete Step 7: Review Final Costs. At this time, the system edits for inconsistencies in the final review and may return an error message. The Plan Sponsor is not permitted to complete Step 7 if all costs for the application have been rejected or all costs are rejected for a Benefit Option included in an interim payment.

If no errors are detected in the final review, a Verification page appears and the Plan Sponsor may proceed with completing Step 7.

Return to top

What Happens After Step 7: Review Final Costs Is Complete

After Step 7: Review Final Costs is complete the status of Step 7 changes to "Complete" and the Last Updated Date and Last Updated By fields are updated accordingly. Step 7 is marked with a green check to indicate that the step is complete and Step 8: Enter Revisions to Final Costs is marked with a blue arrow to indicate that it is the next step. The status of the application remains "Reconciliation Cost Reporting Closed."

After Step 7 is complete, the status of individual cost reports in Step 6: Manage Submission of Final Cost Reports changes to reflect the result of the review. The review status indicates that Step 7 is complete and whether or not the cost report was accepted or rejected.

Step 7 can be reopened as many times as required up and until Step 12: Review and Submit Reconciliation Payment Request is completed. Steps 8 through 11 are marked "Incomplete" as a result of opening the review in Step 7, even if they were previously marked "Complete."

Return to top

Step-by-Step Instructions

This section provides step-by-step instructions to complete the following tasks in Step 7: Review Final Costs:

Complete Step 7: Review Final Costs - Detailed Review

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 7: Review Final Costs.

     Select [Review Final Costs]

On the Step 7: Review Final Costs page:

  1. Select Review Costs from the Actions column of the Benefit Option Summary table to view more detailed cost data for each Benefit Option.

    Note: Two tables display on this page:

    • The Step 7: Review Final Costs table displays the Total Current, Old, and Net costs for the entire application.
    • The Benefit Option Summary table displays the Current, Old, and Net Subsidy Amount for each Benefit Option.

     Select [Review Costs]

On the Step 7: Benefit Option Cost Review page:

  1. Select View Costs in the Actions column of the Benefit Option Cost Reporting Sources List table to review specific cost report details.

    Note: If there are multiple cost reporting sources for the Benefit Option, select Review/Reject Costs in the Actions column of the Benefit Option Cost Report List table to view the specific cost report details, reject a specific cost report, or undo a rejection of a cost report.

    Three tables display on this page:

    • The Benefit Option Cost Reporting Sources List shows status, last action date, cost report last submitted, and current Allowable Retiree Costs for each source reporting final costs for the selected Benefit Option.
    • The Plan Year Benefit Option Summary table displays the Current, Old, and Net final cost data and Subsidy Amount for the selected Benefit Option for the entire plan year.
    • The Monthly Benefit Option Summary table displays the Current, Old, and Net final cost data and Subsidy Amount for the each Benefit Option by month.

     Select [View Costs]

On the Step 7: Benefit Option Final Cost Report page:

  1. Review the cost report details for accuracy.
  2. Select Return to Benefit Option Cost Review or select Reject to reject the cost report if the cost report details are not accurate.

     Select [Return to Benefit Option Cost Review]

On the Step 7: Benefit Option Cost Review page:

  1. If there is only one cost report for the Benefit Option, select Complete Benefit Option Review or select Reject to reject the cost report or select Return to Review Final Costs to return to the Step 7: Review Final Costs page without completing this step.

     Select [Complete Benefit Option Review]

On the Step 7: Review Final Costs page:

  1. Review the cost data for each Benefit Option.
  2. Select the checkbox in the Review Complete column of the Benefit Option Summary table for each Benefit Option to indicate that the review is complete.
  3. Select Complete Review for all Benefit Options; select Save to save your review; or select Cancel to return to the Reconciliation Checklist without completing this step. Select [Review Complete checkboxes], Select [Complete Review]

On the Step 7: Review Final Cost Complete Review Verification page:

  1. Select Confirm to complete the review of final costs for the application.

     Select [Confirm]

On the Step 7: Review Final Cost Complete Review Confirmation page:

  1. Select Continue to proceed to the Reconciliation Checklist page.

     Select [Continue]

Return to top

Complete Step 7: Review Final Costs - Without Detailed Review

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 7: Review Final Costs.

     Select [Review Final Costs]

On the Step 7: Review Final Costs page:

  1. Select Check All to indicate the final cost review is complete for all Benefit Options.
  2. Select Complete Review to complete your review; select Save to save your review; or select Cancel to return to the Reconciliation Checklist.

     Select [Review Complete checkboxes], Select [Complete Review]

On the Step 7: Review Final Cost Complete Review Verification page:

  1. Select Confirm to complete the review of final costs for the application.

    Note: Negative amounts displays in red font in parentheses.

     Select [Confirm]

On the Step 7: Review Final Cost Complete Review Confirmation page:

  1. Select Continue to return to the Reconciliation Checklist page.

     Select [Continue]

Return to top

Reject a Final Cost Report

To access the RDS Secure Website and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 7: Review Final Costs.

     Select [Review Final Costs]

On the Step 7: Review Final Costs page:

  1. Select Review Costs in the Actions column of the Benefit Option Summary table to examine detailed cost data reported for a Benefit Option.

     Select [Review Costs]

On the Benefit Option Cost Review page:

  1. Select Reject to reject the final cost report.

    Notes:

    • Reject appears if one source has reported final costs for the Benefit Option.
    • If multiple sources are reporting final costs for the Benefit Option, Reject does not appear on the Benefit Option Cost Review page. To reject when multiple sources are reporting final costs for the Benefit Option, select Review/Reject in the Actions column of the Benefit Option Cost Reporting Sources List table to display the Benefit Option Final Cost Report page.

     Select [Reject]

On the Step 7: Review Final Costs page:

  1. The status of the Benefit Option on the Benefit Option Summary Table displays "All Reports Rejected" and the Current Subsidy Amount displays a zero amount.

     All Reports Rejected and Current Subsidy Amount

Return to top

Undo Reject of Final Cost Report

To access the RDS Secure Website, and navigate to the Reconciliation Checklist page, refer to instructions to access the Reconciliation Checklist.

On the Reconciliation Checklist page:

  1. Select Step 7: Review Final Costs.

     Select [Review Final Costs]

On the Step 7: Review Final Costs page:

  1. Select Review Costs from the Actions column of the Benefit Option Summary table to examine detailed cost data reported for each Benefit Option.

     Select [Review Costs]

On the Benefit Option Cost Review page:

  1. Select Undo Reject to include the costs for the Benefit Option in the final Reconciliation request.

    Notes:

    • Reject appears if one source has reported final costs for the Benefit Option.
    • If multiple sources are reporting final costs for the Benefit Option, Reject does not appear on the Benefit Option Cost Review page. To reject when multiple sources are reporting final costs for the Benefit Option, select Review/Reject in the Actions column of the Benefit Option Cost Reporting Source List table to display the Benefit Option Final Cost Report page.

     Select [Undo Reject]

On the Step 7: Review Final Costs page:

  1. The previously rejected costs are now included in the Current Subsidy Amount in the Benefit Option Summary table for that Benefit Option.

     Current Subsidy Amount

Return to top