Cost Reporting and Review

Hospital Financial Reporting

All reports/documents must be submitted as email attachments to the Department's Cost Reporting Program: costreporting@azdhs.gov.

All hospitals must report using their ADHS facility ID available here.

Required reporting is comprised of the following:
  1. Annual Audited Financial Statement (AFS) copy
  2. Uniform Accounting Report (UAR) which includes:
    1. Arizona Hospital state UAR form (available below)
    2. Medicare Cost Report (MCR) copy
    3. Statement of Cash Flow (unless included in the AFS)
  3. Hospital Charge Description Master (CDM) with Rates & Charges Overview Form (OvF) (available below)
  4. Attestation of Completeness and Accuracy specific to reporting type (available below)
Reporting Instructions:
  1. Annual Audited Financial Statement (AFS)
    The AFS must be from an independent certified public accountant. A copy of the Hospital's AFS in PDF format is due 120 days after the hospital’s fiscal year end. The AFS must be accompanied by an Attestation of Completeness and Accuracy (below). If a hospital is part of a group, a combined AFS may be submitted if the AFS contains a financial statement specific to the hospital. A 30-day filing extension may be requested; extension requests must be in writing and sent to costreporting@azdhs.gov.

    Name your above document files as follows:
    • Audited Financial Statement: Med-9999_CCYYMM_FYCCYY_AFS
      • Med-9999 = ADHS facility ID available here
      • CCYYMM = the year/month you are reporting to the Department; i.e. 201504
      • FYCCYY = the facility fiscal year of this reporting; i.e. FY2014
  2. Uniform Accounting Report (UAR)
    The UAR is due 150 days after the hospital’s fiscal year end. There are no filing extensions for reporting of UAR/MCR. The completed UAR form, Medicare Cost Report copy in PDF format, Statement of Cash Flow (unless included in the AFS) and Attestation of Completeness and Accuracy must be submitted together. Name your above document files as follows:
    • Uniform Accounting Report: MED-9999_CCYYMM_FYCCYY_UAR
    • Medicare Cost Report: MED-9999_CCYYMM_FYCCYY_MCR
    • AFS/UAR Attestation: MED-9999_CCYYMM_FYCCYY_ATT-UAR
      • MED-9999 = ADHS facility ID available here
      • H[SH; RGH]-9999 = your facility license number; i.e. H-1234; SH-1234; RGH-1234
      • CCYYMM = the year/month you are reporting to the Department; i.e. 201504
      • FYCCYY = the facility fiscal year of this reporting; i.e. FY2014
  3. Hospital Charge Description Master (CDM) with Rates & Charges Overview (OvF) Form
    As a prerequisite to operations, Arizona law requires all hospitals to submit a Rates and Charges Package as specified under Arizona Administrative Code R9-11-302 to the Department prior to providing services to patients. Arizona law also requires all hospitals to keep their current rates and charges on file with the Department. To meet the intent of the law, an electronic copy of the hospital’s current CDM, with accompanying OvF and applicable Attestation of Completeness and Accuracy must be submitted annually at the same time the hospital’s other financial reporting documents (as described on this page) are due to the Department. Name your above document files as follows:
    • Chargemaster: H[SH; RGH]-9999_CCYYMM_CDM
    • Overview Form: H[SH; RGH]-9999_CCYYMM_OvF
    • CDM/OvF Attestation: H[SH; RGH]-9999_CCYYMM_ATT-CDM
      • H[SH; RGH]-9999 = your facility license number; i.e. H-1234; SH-1234; RGH-1234
      • CCYYMM = the year/month you are reporting to the Department; i.e. 201504

The requirements for this reporting are found in Arizona Administrative Code, Title 9, Chapter 11, available on the Arizona Secretary of State's web site.