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Skilled Nursing Facility Cost Reports - 2010

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Identification, Utilization, Statistical Data

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Worksheet Section	Description	Reference
Wkst. S,	Skilled Nursing Facility Health Care Complex Cost Report Certification and Settlement Summary	4103
Wkst. S, Part I	Cost Report Status	4103.1
Wkst. S, Part II	Certification	4103.2
Wkst. S, Part III	Settlement Summary	4103.3
Wkst. S-2, Parts I	Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Identification Data	4104
Wkst. S-2, Parts II	Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Reimbursement Questionnaire	4104.1
Wkst. S-3, Parts I	Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Statistical Data	4105
Wkst. S-3, Parts II	“SNF Wage Index Information – Direct Salaries	4105.1
Wkst. S-3, Parts III	“SNF Wage Index Information – Overhead Cost	4105.2
Wkst. S-3, Parts IV	Wage Related Costs	4105.3
Wkst. S-3, Parts V	Reporting of Direct Care Expenditures	4105.4
Wkst. S-4	SNF-Based Home Health Agency Statistical Data	4106
Wkst. S-5	SNF-Based Rural Health Clinic / Federally Qualified Health Center Statistical Data	4107
Wkst. S-6	Skilled Nursing Facility-Based C.M.H.C Statistical Data	4108
Wkst. S-7	Prospective Payment for Skilled Nursing Facilities Statistical Data	4109
Wkst. S-8	Hospice Identification Data	4110
Wkst. S-8, Part I	Enrollment Days Based on Level of Care	4110.1
Wkst. S-8, Part II	Census Data	4110.2

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	4113
Wkst. A-6	Reclassifications	4114
Wkst. A-7	Analysis of Changes During Cost Reporting Period in Capital Asset Balances	4115
Wkst. A-8	Adjustments to Expenses	4116
Wkst. A-8-1	Statement of Costs of Services From Related Organizations and Home Office Costs	4117
Wkst. A-8-2	Provider-Based Physician Adjustments	4118

Cost and Cost Allocation

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Worksheet Section	Description	Reference
Wkst. B, Part I	Cost Allocation – General Service Costs	4120
Wkst. B, Part II	Allocation of Capital-Related Costs	4121
Wkst. B-1	Cost Allocation – Statistical Basis	4120
Wkst. B-2	Post Step Down Adjustments	4122

Computation of Ratio of Costs to Charges

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Worksheet Section	Description	Reference
Wkst. C	Ratio of Cost to Charges for Ancillary and Outpatient Cost	4123

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

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Worksheet Section	Description	Reference
Wkst. D	Apportionment of Ancillary and Outpatient Cost	4124
Wkst. D, Part I	Calculation of Ancillary Cost and Outpatient Cost	4124.1
Wkst. D, Part II	Apportionment of Vaccine Cost	4124.2
Wkst. D, Part III	Calculation of Pass Through Costs for Nursing & Allied Health	4124.3
Wkst. D-1, Parts I	Calculation of Inpatient Routine Costs	4125.1
Wkst. D-1, Part II	Calculation of Inpatient Nursing & Allied Health Cost for PPS Pass through	4125.2

Calculation of Reimbursement Settlement

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Worksheet Section	Description	Reference
Wkst. E	Calculation of Reimbursement Settlement Title XVIII	4130
Wkst. E, Part I	SNF Reimbursement Under PPS	4130.1
Wkst. E, Part II	Calculation of Reimbursement Settlement for Title V and Title XIX Only	4130.2
Wkst. E-1	Analysis of Payments to Providers for Services Rendered	4131

Financial Statements

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Worksheet Section	Description	Reference
Wkst. G	Balance Sheet	4140.1
Wkst. G-1	Statement of Changes in Fund Balances	4140.2
Wkst. G-2, Parts I & II	Statement of Patient Revenues and Operating Expenses	4140.3
Wkst. G-3	Statement of Revenues and Expenses	4140.4

Provider Based Home Health Agency

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Worksheet Section	Description	Reference
Wkst. H	Analysis of Provider-Based Home Health Agency Costs	4141
Wkst. H-1	Cost Allocation HHA General Service Cost	4142
Wkst. H-2, Part I	Allocation of General Service Costs to HHA Cost Centers	4143.1
Wkst. H-2, Part II	Allocation of General Service Costs to HHA Cost Centers Statistical Basis	4143.2
Wkst. H-3	Apportionment of Patient Service Costs	4144
Wkst. H-3, Part I	Computation of the Aggregate Program Cost	4144.1
Wkst. H-3, Part II	Apportionment of Cost of HHA Services Furnished by Shared SNF Departments	4144.2
Wkst. H-4	Calculation of HHA Reimbursement Settlement	4145
Wkst. H-4, Part I	Computation of the Lesser of Reasonable Cost or Customary Charges	4145.1
Wkst. H-4, Part II	Computation of HHA Reimbursement Settlement	4145.2
Wkst. H-5	Analysis of Payments to Provider-based HHA for Services Rendered to Program Beneficiaries	4146

Provider Based Hospice

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Worksheet Section	Description	Reference
Wkst. K	Analysis of SNF – Based Hospice Cost	4157
Wkst. K-1	Hospice Compensation Analysis Salaries and Wages	4158
Wkst. K-2	Hospice Compensation Analysis – Employee Benefits (Payroll Related)	4159
Wkst. K-3	Hospice Compensation Analysis – Contracted Services/Purchased Services	4160
Wkst. K-4, Parts I & II	Cost Allocation Hospice General Service Cost Hospice Statistical Basis	4161
Wkst. K-5	Allocation of General Service Costs to Hospice Cost Centers	4162
Wkst. K-5 Part I	Allocation of General Service Costs to Hospice Cost Centers	4162.1
Wkst. K-5 Part II	Allocation of General Service Costs to Hospice Cost Centers – Statistical Basis	4162.2
Wkst. K-5 Part III	Apportionment of Hospice Shared Services	4162.3
Wkst. K-6	Calculation of Per Diem Cost	4163

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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