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Skilled Nursing Facility Cost Reports - 1996

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Identification, Utilization, Statistical Data

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Worksheet Section	Description	Reference
Wkst. S, Parts I & II	Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report: Certification and Summary	3506-3506.2
Wkst. S-2	Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Identification Data	3508
Wkst. S-3, Parts I	Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Statistical Data	3509
Wkst. S-3, Parts II & III	SNF Wage Index Information	3509.1-3509.2
Wkst. S-4	SNF-Based Home Health Agency Statistical Data	3511
Wkst. S-4, Part I	Home Health Agency Visits	3511.1
Wkst. S-4, Part II	Employment Data	3511.2
Wkst. S-4, Part III	Compilation of PPS Activity Data	3511.3
Wkst. S-5	SNF-Based Rural Health Clinic / Federally Qualified Health Center Statistical Data	3512
Wkst. S-6	Skilled Nursing Facility-Based Outpatient Rehabilitation Statistical Data	3513
Wkst. S-7, Parts I, II, III & IV	NHCMQ Demonstration and PPS Statistical Data	3514
Wkst. S-7, Part I	NHCMQ Demonstration Statistical Data	3514.1
Wkst. S-7, Part II	PPS Statistical Data	3514.2
Wkst. S-7, Part III	PPS Statistical Data	3514.3
Wkst. S-7, Part IV	PPS Statistical Data for Electronic Filing	3514.4
Wkst. S-8	Hospice Identification Data	3515
Wkst. S-8, Part I	Enrollment Days Based on Level of Care	3515.1
Wkst. S-8, Part II	Census Data	3515.2

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	3516
Wkst. A-6	Reclassifications	3517
Wkst. A-7	Analysis of Changes During Cost Reporting Period in Capital Asset Balances	3518
Wkst. A-8	Adjustments to Expenses	3519
Wkst. A-8-1	Statement of Costs of Services From Related Organizations	3520
Wkst. A-8-2	Provider-Based Physician Adjustments	3521

Cost and Cost Allocation

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Worksheet Section	Description	Reference
Wkst. B, Part I	Cost Allocation – General Service Costs and	3524
Wkst. B, Part II	Cost Allocation – General Service Costs and Allocation of Capital-Related Costs	3524
Wkst. B, Part III	Cost Allocation – Statistical Basis (With Less Than 1500 Medicare Days	3524.1
Wkst. B-1	Cost Allocation – Statistical Basis	3524
Wkst. B-2	Post Step Down Adjustments	3526

Computation of Ratio of Costs to Charges

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Worksheet Section	Description	Reference
Wkst. C	Computation of Rate of Cost to Charges	3527

Apportionment of Inpatient Cost (Routine, Ancillary, Capital), Computation of Operating Cost

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Worksheet Section	Description	Reference
Wkst. D, Parts I, II & III	Apportionment of Ancillary and Outpatient Cost and Reduction of Therapy Cost	3530
Wkst. D, Part I	Calculation of Ancillary Cost and Outpatient Cost Apportionment	3530.1
Wkst. D, Part II	Apportionment of Vaccine Cost	3530.2
Wkst. D, Part III	Calculation of Interns and Residents Pass Through for PPS SNF	3530.3
Wkst. D-1, Parts I & II	Computation of Inpatient Routine Costs	3531
Wkst. D-1, Part I	Calculation of Inpatient Routine Costs	3531.1
Wkst. D-1, Part II	Calculation of Inpatient Intern and Resident Cost for PPS Passthrough	3531.2
Wkst. D-2, Parts I & II	Apportionment of Cost of Services Rendered By Interns and Residents	3532
Wkst. D-2, Part I	Not in Approved Teaching Program	3532.1
Wkst. D-2, Part II	In Approved Teaching Program (Title VIII, Part B Inpatient Routine Costs Only)	3532.2

Calculation of Reimbursement Settlement

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Worksheet Section	Description	Reference
Wkst. E, Parts I, II, III & V	Calculation of Reimbursement Settlement	3534
Wkst. E, Part I	Part A – Inpatient Services	3534.1
Wkst. E, Part II	Part B – Medical and Other Health Services	3534.2
Wkst. E, Part III	SNF Reimbursement Under PPS	3534.3
Wkst. E, Part V	SNF Reimbursement Under NHCHQ Demonstration	3534.4
Wkst. E-1	Analysis of Payments to Providers for Services Rendered	3535

Financial Statements

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Worksheet Section	Description	Reference
Wkst. G	Balance Sheet	3536
Wkst. G-1	Statement of Changes in Fund Balances	3536.1
Wkst. G-2, Parts I & II	Statement of Patient Revenues and Operating Expenses	3536.2
Wkst. G-3	Statement of Revenues and Expenses	3536.3

Provider Based Home Health Agency

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Worksheet Section	Description	Reference
Wkst. H	Analysis of Provider-Based Home Health Agency Costs	3539
Wkst. H-1	Compensation Analysis – Salaries and Wages	3540
Wkst. H-2	Compensation Analysis – Employee Benefits (Payroll-Related)	3541
Wkst. H-3	Compensation Analysis – Contracted Services/Purchased Services	3542
Wkst. H-4, Parts I & II	Allocation of HHA Administrative and General Costs	3543
Wkst. H-4, Part I	Allocation of HHA Administrative and General Costs	3543.1
Wkst. H-4, Part II	Apportionment of Cost of HHA Services Furnished by Shared Skilled Nursing Facility Departments	3543.2
Wkst. H-5, Parts I – V	Apportionment of Patient Service Costs	3544
Wkst. H-5, Part I	Aggregate Agency Cost Per Visit Computation	3544.1
Wkst. H-5, Part II	Computation of Aggregate Medicare Cost and the Aggregate of the Medicare Limitation	3544.2
Wkst. H-5, Part III	Supplies and Drugs Cost Computation	3544.3
Wkst. H-5, Part IV	Comparison of the Lesser of the Aggregate Medicare Cost,The Aggregate of the Medicare Cost Per Visit Limitation and the Aggregate Per Beneficiary Cost Limitation	3544.4
Wkst. H-5, Part V	Outpatient Therapy Reduction Computation	3544.5
Wkst. H-6, Parts I & II	Calculation of HHA Reimbursement Settlement Part A and Part B Services	3545
Wkst. H-6, Part I	Computation of Lesser of Reasonable Cost or Customary Charges	3545.1
Wkst. H-6, Part II	Computation of HHA Reimbursement Settlement	3545.2
Wkst. H-7	Analysis of Payments to Provider-Based Home Health Agencies for Services Rendered to Program Beneficiaries	3546

Provider Based Hospice

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Worksheet Section	Description	Reference
Wkst. K	Analysis of SNF – Based Hospice Cost	3565
Wkst. K-1	Hospice Compensation Analysis Salaries and Wages	3566
Wkst. K-2	Hospice Compensation Analysis – Employee Benefits (Payroll Related)	3567
Wkst. K-3	Hospice Compensation Analysis – Contracted Services/Purchased Services	3568
Wkst. K-4, Parts I & II	Cost Allocation Hospice General Service Cost Hospice Statistical Basis	3569
Wkst. K-5	Allocation of General Service Costs to Hospice Cost Centers	3570
Wkst. K-5 Part I	Allocation of General Service Costs to Hospice Cost Centers	3570.1
Wkst. K-5 Part II	Allocation of General Service Costs to Hospice Cost Centers – Statistical Basis	3570.2
Wkst. K-5 Part III	Apportionment of Hospice Shared Services	3570.3
Wkst. K-6	Calculation of Per Diem Cost	3571

About Skilled Nursing Facility Reports:

Skilled Nursing Facilities (SNFs) participating in the Medicare program submit annually to CMS cost reports in a standardized electronic format. SNFs file the form CMS-2540-96 in accordance with 42-CFR Part 413.20 and the Provider Reimbursement Manual Part I. Hospital-based SNFs continue to use Form CMS 2552-96 Hospital and Hospital Health Care Complex Cost Report.

The SNF cost reports are a valuable database and provide unique nationwide information for facility characteristics, utilization, cost, charges, reimbursement, financial and income statements.

The Healthcare Cost Report Information System (HCRIS) for SNFs collects annually Facility Cost Report -Data files and stores them in a relational database. The database is continuously updated and is made public quarterly (March, June, September, and December).

Idatareport makes all data available in many formats (Excel, SAS, Stata, etc) ready for download. The data is available by PPS year in the familiar worksheet format for all reporting facilities or customized reports.

HCRIS keeps the highest level of SNF cost report based on its status. From lowest to highest the report status is: as submitted, Settled without audit, Settled with audit, Reopened, Amended.

Many times SNFs submit more than one cost report for a FY with the same status. This can happen if a change in ownership or FY occurs during the year. Idatareport flags the duplicate reports and selects the most representative (e.g., higher number of months) for the analysis. A reporting length indicator is calculated and included with every data set.

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