Identification, Utilization, Statistical Data
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. S | Independent Renal Dialysis Facility Cost Report Certification | 3404 |
| Wkst. S, Parts I | General | 3404.1 |
| Wkst. S, Parts II | Certification by Officer or Administrator of Facility | 3404.2 |
| Wkst. S-1 | Independent Renal Dialysis Facility Statistical Data | 3405 |
Reclassification And Adjustment Of Trial Balance Of Expenses
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. A | Reclassification and Adjustment of Trial Balance of Expenses | 3406 |
| Wkst. A-1 | Reclassifications | 3407 |
| Wkst. A-2 | Adjustments to Expenses | 3408 |
| Wkst. A-3 | Statement of Costs of Services From Related Organizations | 3409 |
| Wkst. A-4 | Statements of Total Compensation to Owners/Administrators/Medical Directors etc | 3410 |
Cost and Cost Allocation
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. B | Cost Allocation – General Service Costs | 3411 |
| Wkst. B-1 | Cost Allocation – Statistical Basis | 3411 |
Computation of Average Cost Per Treatment
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. C | Computation of Average Cost Per Treatment | 3412 |
Calculation of Reimbursable Bad Debts (Title XVIII-Part B)
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| Worksheet Section | Description | Reference |
|---|---|---|
| Wkst. D | Calculation of Reimbursable Bad Debts – Title XVIII, Part B | 3413 |