In the 2026 Outpatient Prospective Payment System (OPPS) Final Rule with comment period (CMS-1834-FC), issued on November 21, 2025, CMS finalized the proposal to amend 42 CFR 413.20(d)(3) to require hospitals to report the median payer-specific negotiated charge that the hospital has negotiated with all of its Medicare Advantage Organizations (MAOs) on the Medicare cost report. This data collection requirement is effective for cost reporting periods ending on or after January 1, 2026. The requirement applies to subsection (d) hospitals paid under the Inpatient Prospective Payment System (IPPS).
Worksheet S-12 of the Medicare cost report was introduced to collect this data. Worksheet S-12 was established by Provider Reimbursement Manual, Part 2, Chapter 40, Form CMS-2552-10, Transmittal 25, and updated by Transmittal 26, to report the weighted median of the payer-specific negotiated charges the hospital has negotiated with each MAO for each MS-DRG. The weighted median is determined from the payer-specific negotiated charges in the hospital's most recent machine-readable file (MRF) as of the cost report filing date. It is weighted by the hospital's inpatient discharges for each MAO by MS-DRG during the cost reporting period.
Worksheet S-12 Reviews
The Worksheet S-12 Review Contractor is Myers & Stauffer, conducting these reviews on behalf of CMS. Impacted hospitals will receive an information request letter from the contractor informing them that the cost report is being reviewed to ensure that the data reported on Worksheet S-12 is accurate. Providers will be required to respond within the timeframe specified in the letter, providing the information and documentation requested in the letter to support their reported Worksheet S-12 data.
These reviews are in addition to any cost report audit activities completed by the Medicare Administrative Contractors (MACs). Myers & Stauffer will work closely with the servicing MACs to obtain cost reports and other necessary information. Any adjustments resulting from the Worksheet S-12 reviews completed by Myers & Stauffer will be incorporated in cost report settlements completed by the MACs.
CY 2026 OPPS/ASC Final Rule with Comment Period (CMS-1834-FC)
Provider Reimbursement Manual, Part 2, (Pub. 15-2), Form CMS-2552-10