CMS-2552-10 Revisions - Crosswalk from old to new

Revisions to Form CMS-2552-10 HOSPITAL COST REPORT APPLICATION/UPDATE FORM

The last major revision to the hospital cost report was 1996. This major revision of the Hospital Cost Report is undertaken to eliminate any and all worksheets that are no longer needed for rate setting or refinement purposes which impact the accuracy of Medicare payments. This revision will also be incorporating worksheet and instructions to capture information currently reported manually on Provider Cost Report Reimbursement Questionnaire FORM CMS-339 (OMB NO. 0938-0301). The overall burden to providers will be decreased due the provider just completing and submitting one composite electronic file for the new 2552-10 will not be required to submit the FORM CMS-339.

Changes

Issue #	Instructions Page #	Form Page #	Section	Old Package Form CMS -2552-96	New Package Form CMS – 2552-10	Reason for the Change Application of the instructions and accompanying worksheets	Burden Effect
1	40-26-40-28	40-503	4003	S	S, Parts I, II & III	Added Part I for cost report status, Part II now certification and Part III is now the certification summary. Added a HIT Settlement column to track the HIT payments made by the MACs	N/A
2	40-29-40-36	40-504-40-507	4004.1	S-2	S-2, Part I	Expanded the questions that will generate other worksheets on the cost report generate other worksheets on the cost Added lines 15 and 16 for RHC/FQHC. report. Added line 19 “Other” to be reserved for future use. Clarified line 22, added a “P” response for “Pickle Amendment”. Added line 23 to account for the method used to account for Medicaid days. Added line 24 for labor and delivery for Title 19 and DSH calculation. Added lines 95 – 98 to accommodate Title XIX reduction for capital and operating cost to activate Worksheet C, Part II. Modified line 140 dealing with chain home office numbers.	N/A
3	40-37-40-54	40-508-40-509	4004.2		S-2, Part II	Included the Hospital Cost Report Questionnaire FORM CMS-339 (OMB NO. 0938-0301) into CMS-2552-10.	Increase

Issue #	Instructions Page #	Form Page #	Section	Old Package Form CMS -2552-96	New Package Form CMS – 2552-10	Reason for the Change Application of the instructions and accompanying worksheets	Burden Effect
4	40-55- 40-58	40-510-40-511	4005.1	S-3, Part I	S-3, Part I	Re-designated the subscripted lines and columns into whole number lines and columns. Eliminated columns 9 – 12 dealing with observation beds for Titles XVIII and XIX. Added column 1 for cross reference to worksheet A. Opened lines 14 and 15 for column 2 (numbers of beds). Added line 30 labor and delivery days for Title XIX, column 7 and for the total facility column 8 total.	N/A
5	40-59- 40-64	40-512-40-513	4005.2- 4005.3	S-3, Parts II & III	S-3, Parts II & III	Re-designated the subscripted lines and columns into whole number lines and columns. Modified column 1 (cross references to Worksheet A)	N/A
6	40-65	40-514	4005.4		S-3, Part IV	New worksheet to capture wage related that was formerly on the hospital cost report questionnaire FORM CMS-339.	Increase
7	40-65	40-515	4005.5		S-3, Part V	New worksheet to capture Contract labor and Benefit Cost.	Increase
8	40-66- 40-68	40-516	4006	S-4	S-4	Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
9	40-69- 40-70	40-517	4007	S-5	S-5	Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
10	40-71	40-518	4008	S-6	S-6	Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
11	40-72	40-519-40-520	4009	S-7	S-7	This new redesigned worksheet provides all of the statistics for hospital based skilled nursing facility (SNFs).	Decrease
12	40-73	40-521	4010	S-8	S-8	Minor changes Eliminated lines 10 & 11 for Physicians identification	N/A
13	40-74 – 40-76	40-522	4011	S-9	S-9	No Change	N/A
14	40-77 – 40-80	40-523	4012	S-10	S-10	Redesigned the whole worksheet
15	40-81 – 40-96	40-524-40-526	4013	A	A	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	Decrease
Issue #	Instructions Page #	Form Page #	Section	Old Package Form CMS -2552-96	New Package Form CMS – 2552-10	Reason for the Change Application of the instructions and accompanying worksheets	Burden Effect
16	40-97 – 40-98	40-527	4014	A-6	A-6	Eliminated column 10, for cross reference to Worksheet A-7	Decrease
17	40-99 – 40-101	40-528	4015	A-7, Part I - III	A-7, Part I - III	Minor changes to conform to Worksheet A. Added line 7 to track HIT assets	N/A
18	40-102 – 40-104	40-529	4016	A-8	A-8	Minor changes to conform to Worksheet A.	N/A
19	40-105	40-530	4017	A-8-1	A-8-1	Minor changes to conform to Worksheet A.	N/A
20	40-106 – 40-108	40-531	4018	A-8-2	A-8-2	No change	N/A
21	40-109 – 40-113	40-532 – 40534	4019	A-8-3, Parts I-VII	A-8-3, Parts I- VII	Designated the worksheet for cost reimbursed providers.
22				A-8-4		Eliminated	Decrease
23	40-114- 40-118	40-535 – 40-543	4020	B, Part I	B, Part I	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	Decrease
24	40-119 – 40-120	40-553 – 40-561	4020	B-1	B-1	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	Decrease
25	40-121 – 40-123	40-544 - 40-552	4021	B, Part III	B, Part II	Allocation of Capital Related Cost. Re-designated the subscripted lines and columns into whole number lines and columns.	Decrease
26	40-124	40-562	4022	B-2	B-2	Minor changes to conform to Worksheet A.	N/A
27	40-125 – 40-131	40-563 – 40-566	4023	C, Part I- II	C, Part I - II	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.
28				C, Parts III - IV	C, Parts III –IV	Eliminated	Decrease
29	40-132 – 40-138	40-567 – 40-572	4024	D, Parts I - V	D, Parts I - V	Minor changes.	N/A
Issue #	Instructions Page #	Form Page #	Section	Old Package Form CMS -2552-96	New Package Form CMS – 2552-10	Reason for the Change Application of the instructions and accompanying worksheets	Burden Effect
30	40-139 – 40-150	40-573 – 40-575	4025	D-1	D-1	Minor changes	N/A
31	40-151 – 40-155	40-576 – 40-577	4026	D-2	D-2	Minor changes	N/A
32	40-156 – 40-158	40-578	4027	D-4	D-3	Renamed D-4 to D-3 and made minor changes.	N/A
33	40-159 – 40-163	40-579 – 40-581	4028	D-6	D-4	Renamed D-6 to D-4 and made minor changes	N/A
34	40-164 – 40-166	40-582 – 40-583	4029	D-9	D-5	Renamed D-9 to D-5 and made minor changes	N/A
35	40-167 – 40-174	40-584 – 40-585	4030.1	E, Part A	E, Part A	Re-designated the worksheet to eliminate obsolete lines and convert subscripted lines into whole number lines.	N/A
36	40-175 – 40-180	40-586 – 40-587	4030.2	E, Part B	E, Part B	Re-designated the worksheet to eliminate obsolete lines and convert subscripted lines into whole number lines.	N/A
37				E, Part C		Eliminated	Decrease
38				E, Part D		Eliminated	Decrease
39				E, Part E		Eliminated	Decrease
40	40-181 – 40-183	40-588	4031	E-1	E-1, Part I	Minor changes Eliminated the signature line	N/A
41		40-589	4031.1		E-1, Part II	Added a new worksheet to track the additional payments made by the MAC for HIT acquisitions	Increase
42	40-184 – 40-186	40-590	4032	E-2	E-2	Minor changes	N/A
43	40-187 – 40-189	40-591	4033.1	E-3, Part I	E-3, Part I	Major changes. The worksheet is now to be used exclusively by TEFRA reimbursed providers.	Increase
44	40-190 – 40-193	40-592	4033.2		E-3, Part II	New worksheet to be used exclusively by Inpatient Psychiatric Providers.	N/A
45	40-194 – 40-197	40-593	4033.3		E-3, Part III	New worksheet to be used exclusively by Inpatient Rehabilitation Providers.	N/A
46	40-198 – 40-200	40-594	4033.4		E-3, Part IV	New worksheet to be used exclusively by Long Term Care Providers.	N/A
Issue #	Instructions Page #	Form Page #	Section	Old Package Form CMS -2552-96	New Package Form CMS – 2552-10	Reason for the Change Application of the instructions and accompanying worksheets	Burden Effect
47	40-201 – 40-203	40-595	4033.5	E-3, Part II	E-3, Part V	Major changes. The worksheet is now to be used by cost reimbursed providers only.	N/A
48	40-204 – 40-205	40-596	4033.6	E-3, Part III	E-3, Part VI	Major changes. The worksheet now applies to Title XVIII SNF reimbursement.	N/A
49	40-206 – 40-208	40-597	4033.7		E-3, Part VII	New worksheet for Title V & XIX SNF Reimbursement.	N/A
50	40-209 – 40-214	40-598 – 40-599	4034	E-3, Part IV	E-4	New worksheet to calculate Direct Graduate Medical Education and ESRD Direct Graduate Medical. Education	N/A
51	40-215	40-600 – 40-604	4040	G, G-1, G-2, and G-3	G, G-1, G-2, and G-3	Minor changes. Re-designated the subscripted lines and into whole number lines. Added lines 27 and 28 to track HIT assets as well as the related accumulated depreciations	N/A
52	40-216 – 40-219	40-605	4041	H	H	No Change	N/A
53				H-1		Eliminated worksheet. Data is now included on Worksheet H.	N/A
54				H-2		Eliminated worksheet. Data is now included on Worksheet H.	N/A
55				H-3		Eliminated worksheet. Data is now included on Worksheet H.	N/A
56	40-220 – 40-223	40-606- 40-607	4042	H-4, Parts I & II	H-1, Parts I & II	Renamed the worksheet and Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
57	40-224 – 40-225	40-608 – 40-613	4043	H-5, Parts I & II	H-2, Parts I & II	Renamed the worksheet and Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
58	40-226 – 40-228	40-614	4044	H-6	H-3	Redesigned and renamed the worksheet to eliminate obsolete data requirements.	N/A
59	40-229 – 40-232	40-615	4045	H-7	H-4	Re-designated the worksheet to eliminate obsolete lines and convert subscripted lines into whole number lines.	N/A
60	40-233	40-616	4046	H-8	H-5	Renamed the worksheet with some minor changes Eliminated the signature line	N/A
Issue #	Instructions Page #	Form Page #	Section	Old Package Form CMS -2552-96	New Package Form CMS – 2552-10	Reason for the Change Application of the instructions and accompanying worksheets	Burden Effect
61	40-234 – 40-242	40-617 – 40-621	4047	I-1, I-2, I-3, I-4, & I-5	I-1, I-2, I-3, I-4, & I-5	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
62	40-243 – 40-248	40-622 – 40-631	4053	J-1, J-2, J-3, & J-4	J-1, J-2, J-3, & J-4	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns. These worksheets are now only applicable to CMHC. Eliminated the signature line	N/A
63	40-249 – 40-262	40-632 – 40-645	4063	K, K-1, K-2, K-3, K-4, Parts I&II K-5, Parts I- III, & K-6	K, K-1, K-2, K-3, K-4, Parts I&II K-5, Parts I- III, & K-6	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
64	40-263 – 40-266	40-646	4064	L	L	Updated the worksheet re-designated the subscripted lines into whole lines and eliminated the whole harmless section.	N/A
65	40-267 – 40-269	40-647 – 40-658	4065	L-1, Parts I – II	L-1, Parts I – III	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	N/A
66	40-270 – 40-276	40-659- 40-663	4066	M-1, M-2, M-3, M-4, & M-5	M-1, M-2, M-3, M-4, & M-5	Eliminated “Old Capital” “New Capital” designation. Re-designated the subscripted lines and columns into whole number lines and columns.	N/A

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