Identification, Utilization, Statistical Data

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Wkst. S Outpatient Rehabilitation Provider Cost Report 1802
Wkst. S, Parts I Identification Data 1802.1
Wkst. S, Parts II Certification by Officer or Administrator of Provider(s) 1802.2
Wkst. S, Parts III Settlement Summary 1802.3
Wkst. S, Parts IV Outpatient Rehabilitation Provider Statistical Data 1802.4
Wkst. S-1 Analysis of Payments to Outp. Rehab. Providers for Services Rendered to Program Beneficiaries 1803

Reclassification And Adjustment Of Trial Balance Of Expenses

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Wkst. A Reclassification and Adjustment of Trial Balance of Expenses 1804
Wkst. A-1 Reclassification 1805
Wkst. A-3 Adjustments to Expenses 1806
Wkst. A-3-1 Statement of Costs of Services From Related Organizations 1807
Wkst. A-8-2 Provider-Based Physician Adjustments 1813
Wkst. A-8-3, Parts I-VI Reasonable Cost Determination for Physical Therapy Services Furnished by Outside Suppliers 1814
Wkst. A-8-4, Parts I-V Reasonable Cost Determination For Respiratory Therapy Services Furnished By Outside Suppliers 1815
Wkst. A-8-5, Parts I-VI Reasonable Cost Determination For Therapy Services Furnished By Outside Suppliers On Or After April 10, 1998 1816

Calculation of Reimbursement Settlement

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Wkst. D Calculation of Reimbursement Settlement For Outpatient Rehabilitation Services Title XVIII 1810
Wkst. D, Parts I Computation of Reimbursement Settlement 1810.1
Wkst. D, Parts II Computation of Lesser of Reasonable Cost or Customary Charges 1810.2