11-17 FORM CMS (Cont.) COST ALLOCATION - GENERAL SERVICE COSTS PROVIDER CCN: PERIOD: WORKSHEET B, FROM PART I TO NET EXPENSES CAPITAL
|
|
|
- Easter Barnett
- 5 years ago
- Views:
Transcription
1 NET EXPENSES CAPITAL FOR COST RELATED COSTS ALLOCATION EMPLOYEE ADMINIS- MAIN- COST CENTER DESCRIPTIONS (from Wkst. BLDGS. & MOVABLE BENEFITS SUBTOTAL TRATIVE & TENANCE & OPERATION A col. 7) FIXTURES EQUIPMENT DEPARTMENT (cols. 0-4) GENERAL REPAIRS OF PLANT A GENERAL SERVICE COST CENTERS 1 Capital Related Costs-Buildings and Fixtures 1 2 Capital Related Costs-Movable Equipment 2 4 Employee Benefits Department 3 5 Administrative and General 4 6 Maintenance and Repairs 5 7 Operation of Plant 6 8 Laundry and Linen Service 7 9 Housekeeping 8 10 Dietary 9 11 Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records & Medical Records Library Social Service Other General Service (specify) Nonphysician Anesthetists Nursing School Intern & Res. Service-Salary & Fringes (Approved) Intern & Res. Other Program Costs (Approved) Paramedical Education Program (specify) 22 INPATIENT ROUTINE SERVICE COST CENTERS 30 Adults and Pediatrics (General Routine Care) Intensive Care Unit Coronary Care Unit Burn Intensive Care Unit Surgical Intensive Care Unit Other Special Care Unit (specify) Subprovider IPF Subprovider IRF Subprovider (specify) Nursery Skilled Nursing Facility Nursing Facility Other Long Term Care 46 FORM CMS ( ) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4020) Rev
2 4090 (Cont.) FORM CMS NET EXPENSES CAPITAL FOR COST RELATED COSTS ALLOCATION EMPLOYEE ADMINIS- MAIN- COST CENTER DESCRIPTIONS (from Wkst. BLDGS. & MOVABLE BENEFITS SUBTOTAL TRATIVE & TENANCE & OPERATION A col. 7) FIXTURES EQUIPMENT DEPARTMENT (cols. 0-4) GENERAL REPAIRS OF PLANT A ANCILLARY SERVICE COST CENTERS 50 Operating Room Recovery Room Labor Room and Delivery Room Anesthesiology Radiology-Diagnostic Radiology-Therapeutic Radioisotope Computed Tomography (CT) Scan Magnetic Resonance Imaging (MRI) Cardiac Catheterization Laboratory PBP Clinical Laboratory Services-Program Only Whole Blood & Packed Red Blood Cells Blood Storing, Processing, & Trans Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Implantable Devices Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Other Ancillary (specify) Allogeneic Stem Cell Acquisition 77 OUTPATIENT SERVICE COST CENTERS 88 Rural Health Clinic (RHC) Federally Qualified Health Center (FQHC) Clinic Emergency Observation Beds Other Outpatient Service (specify) Partial Hospitalization Program Rev. 12
3 NET EXPENSES CAPITAL FOR COST RELATED COSTS ALLOCATION EMPLOYEE ADMINIS- MAIN- COST CENTER DESCRIPTIONS (from Wkst. BLDGS. & MOVABLE BENEFITS SUBTOTAL TRATIVE & TENANCE & OPERATION A col. 7) FIXTURES EQUIPMENT DEPARTMENT (cols. 0-4) GENERAL REPAIRS OF PLANT A OTHER REIMBURSABLE COST CENTERS 94 Home Program Dialysis Ambulance Services Durable Medical Equipment-Rented Durable Medical Equipment-Sold Other Reimbursable (specify) Outpatient Rehabilitation Provider (specify) Intern-Resident Service (not appvd. tchng. prgm.) Home Health Agency 101 SPECIAL PURPOSE COST CENTERS 105 Kidney Acquisition Heart Acquisition Liver Acquisition Lung Acquisition Pancreas Acquisition Intestinal Acquisition Islet Acquisition Other Organ Acquisition (specify) Ambulatory Surgical Center (Distinct Part) Hospice Other Special Purpose (specify) SUBTOTALS (sum of lines 1 through 117) 118 NONREIMBURSABLE COST CENTERS 190 Gift, Flower, Coffee Shop, & Canteen Research Physicians' Private Offices Nonpaid Workers Other Nonreimbursable (specify) Cross Foot Adjustments Negative Cost Centers TOTAL (sum lines 118 through 201) 202 Rev
4 4090 (Cont.) FORM CMS LAUNDRY MAIN- NURSING CENTRAL MEDICAL COST CENTER DESCRIPTIONS & LINEN HOUSE- TENANCE OF ADMINIS- SERVICES & RECORDS & SOCIAL SERVICE KEEPING DIETARY CAFETERIA PERSONNEL TRATION SUPPLY PHARMACY LIBRARY SERVICE GENERAL SERVICE COST CENTERS 1 Capital Related Costs-Buildings and Fixtures 1 2 Capital Related Costs-Movable Equipment 2 4 Employee Benefits Department 3 5 Administrative and General 4 6 Maintenance and Repairs 5 7 Operation of Plant 6 8 Laundry and Linen Service 7 9 Housekeeping 8 10 Dietary 9 11 Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records & Medical Records Library Social Service Other General Service (specify) Nonphysician Anesthetists Nursing School Intern & Res. Service-Salary & Fringes (Approved) Intern & Res. Other Program Costs (Approved) Paramedical Education Program (specify) 22 INPATIENT ROUTINE SERVICE COST CENTERS 30 Adults and Pediatrics (General Routine Care) Intensive Care Unit Coronary Care Unit Burn Intensive Care Unit Surgical Intensive Care Unit Other Special Care Unit (specify) Subprovider IPF Subprovider IRF Subprovider (specify) Nursery Skilled Nursing Facility Nursing Facility Other Long Term Care 46 FORM CMS ( ) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4020) Rev. 12
5 LAUNDRY MAIN- NURSING CENTRAL MEDICAL COST CENTER DESCRIPTIONS & LINEN HOUSE- TENANCE OF ADMINIS- SERVICES & RECORDS & SOCIAL SERVICE KEEPING DIETARY CAFETERIA PERSONNEL TRATION SUPPLY PHARMACY LIBRARY SERVICE ANCILLARY SERVICE COST CENTERS 50 Operating Room Recovery Room Labor Room and Delivery Room Anesthesiology Radiology-Diagnostic Radiology-Therapeutic Radioisotope Computed Tomography (CT) Scan Magnetic Resonance Imaging (MRI) Cardiac Catheterization Laboratory PBP Clinical Laboratory Services-Program Only Whole Blood & Packed Red Blood Cells Blood Storing, Processing, & Trans Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Implantable Devices Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Other Ancillary (specify) Allogeneic Stem Cell Acquisition 77 OUTPATIENT SERVICE COST CENTERS 88 Rural Health Clinic (RHC) Federally Qualified Health Center (FQHC) Clinic Emergency Observation Beds Other Outpatient Service (specify) Partial Hospitalization Program Rev
6 4090 (Cont.) FORM CMS LAUNDRY MAIN- NURSING CENTRAL MEDICAL COST CENTER DESCRIPTIONS & LINEN HOUSE- TENANCE OF ADMINIS- SERVICES & RECORDS & SOCIAL SERVICE KEEPING DIETARY CAFETERIA PERSONNEL TRATION SUPPLY PHARMACY LIBRARY SERVICE OTHER REIMBURSABLE COST CENTERS 94 Home Program Dialysis Ambulance Services Durable Medical Equipment-Rented Durable Medical Equipment-Sold Other Reimbursable (specify) Outpatient Rehabilitation Provider (specify) Intern-Resident Service (not appvd. tchng. prgm.) Home Health Agency 101 SPECIAL PURPOSE COST CENTERS 105 Kidney Acquisition Heart Acquisition Liver Acquisition Lung Acquisition Pancreas Acquisition Intestinal Acquisition Islet Acquisition Other Organ Acquisition (specify) Ambulatory Surgical Center (Distinct Part) Hospice Other Special Purpose (specify) SUBTOTALS (sum of lines 1 through 117) 118 NONREIMBURSABLE COST CENTERS 190 Gift, Flower, Coffee Shop, & Canteen Research Physicians' Private Offices Nonpaid Workers Other Nonreimbursable (specify) Cross Foot Adjustments Negative Cost Centers TOTAL (sum lines 118 through 201) Rev. 12
7 INTERN & NON- INTERNS & INTERNS & RESIDENT OTHER PHYSICIAN RESIDENTS RESIDENTS PARAMEDICAL COST & POST COST CENTER DESCRIPTIONS GENERAL ANES- NURSING SALARY AND PROGRAM EDUCATION STEPDOWN SERVICE THETISTS SCHOOL FRINGES COSTS (SPECIFY) SUBTOTAL ADJUSTMENTS TOTAL GENERAL SERVICE COST CENTERS 1 Capital Related Costs-Buildings and Fixtures 1 2 Capital Related Costs-Movable Equipment 2 4 Employee Benefits Department 3 5 Administrative and General 4 6 Maintenance and Repairs 5 7 Operation of Plant 6 8 Laundry and Linen Service 7 9 Housekeeping 8 10 Dietary 9 11 Cafeteria Maintenance of Personnel Nursing Administration Central Services and Supply Pharmacy Medical Records & Medical Records Library Social Service Other General Service (specify) Nonphysician Anesthetists Nursing School Intern & Res. Service-Salary & Fringes (Approved) Intern & Res. Other Program Costs (Approved) Paramedical Education Program (specify) 22 INPATIENT ROUTINE SERVICE COST CENTERS 30 Adults and Pediatrics (General Routine Care) Intensive Care Unit Coronary Care Unit Burn Intensive Care Unit Surgical Intensive Care Unit Other Special Care Unit (specify) Subprovider IPF Subprovider IRF Subprovider (specify) Nursery Skilled Nursing Facility Nursing Facility Other Long Term Care 46 FORM CMS ( ) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4020) Rev
8 4090 (Cont.) FORM CMS INTERN & NON- INTERNS & INTERNS & RESIDENT OTHER PHYSICIAN RESIDENTS RESIDENTS PARAMEDICAL COST & POST COST CENTER DESCRIPTIONS GENERAL ANES- NURSING SALARY AND PROGRAM EDUCATION STEPDOWN SERVICE THETISTS SCHOOL FRINGES COSTS (SPECIFY) SUBTOTAL ADJUSTMENTS TOTAL ANCILLARY SERVICE COST CENTERS 50 Operating Room Recovery Room Labor Room and Delivery Room Anesthesiology Radiology-Diagnostic Radiology-Therapeutic Radioisotope Computed Tomography (CT) Scan Magnetic Resonance Imaging (MRI) Cardiac Catheterization Laboratory PBP Clinical Laboratory Services-Program Only Whole Blood & Packed Red Blood Cells Blood Storing, Processing, & Trans Intravenous Therapy Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Electrocardiology Electroencephalography Medical Supplies Charged to Patients Implantable Devices Charged to Patients Drugs Charged to Patients Renal Dialysis ASC (Non-Distinct Part) Other Ancillary (specify) Allogeneic Stem Cell Acquisition 77 OUTPATIENT SERVICE COST CENTERS 88 Rural Health Clinic (RHC) Federally Qualified Health Center (FQHC) Clinic Emergency Observation Beds Other Outpatient Service (specify) Partial Hospitalization Program Rev. 12
9 INTERN & NON- INTERNS & INTERNS & RESIDENT OTHER PHYSICIAN RESIDENTS RESIDENTS PARAMEDICAL COST & POST COST CENTER DESCRIPTIONS GENERAL ANES- NURSING SALARY AND PROGRAM EDUCATION STEPDOWN SERVICE THETISTS SCHOOL FRINGES COSTS (SPECIFY) SUBTOTAL ADJUSTMENTS TOTAL OTHER REIMBURSABLE COST CENTERS 94 Home Program Dialysis Ambulance Services Durable Medical Equipment-Rented Durable Medical Equipment-Sold Other Reimbursable (specify) Outpatient Rehabilitation Provider (specify) Intern-Resident Service (not appvd. tchng. prgm.) Home Health Agency 101 SPECIAL PURPOSE COST CENTERS 105 Kidney Acquisition Heart Acquisition Liver Acquisition Lung Acquisition Pancreas Acquisition Intestinal Acquisition Islet Acquisition Other Organ Acquisition (specify) Ambulatory Surgical Center (Distinct Part) Hospice Other Special Purpose (specify) SUBTOTALS (sum of lines 1 through 117) 118 NONREIMBURSABLE COST CENTERS 190 Gift, Flower, Coffee Shop, & Canteen Research Physicians' Private Offices Nonpaid Workers Other Nonreimbursable (specify) Cross Foot Adjustments Negative Cost Centers TOTAL (sum lines 118 through 201) 202 Rev
FORM CMS ( 10/99 ) ( INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 3525 ) Rev RELATED COSTS
10-99 FORM CMS 2540-96 3590 (Cont.) DIRECTLY CAP. REL. CAP. REL. EMPLOYEE ADMINIS- PLANT OPER. ASSIGNED BUILDINGS MOVABLE SUBTOTAL BENEFITS TRATIVE MAINTENANCE COST CENTER CAPITAL & FIXTURES EQUIPMENT
Table 8.2 FORM CMS County Hospital - Fiscal Year One Worksheet A
Table 8.2 Worksheet A A-6 Reclassified A-8 Net Expenses Salaries Other Total Reclassifications Trial Balance Adjustments For Allocation Cost Center Descriptions 1 2 3 4 5 6 7 General Service Cost Centers
UB-82 AND UB-92 CONVERSION TABLE - TO BE USED FOR REPORTING NON-INSTITUTIONAL HCSRS
6010.50-M, MAY 1999 DATA REQUIREMENTS CHAPTER 2 ADDENDUM H UB-82 AND UB-92 CONVERSION TABLE - TO BE USED FOR REPORTING NON-INSTITUTIONAL HCSRS The revenue codes listed below are authorized by the National
routine services furnished by nursing facilities (other than NFs for individuals with intellectual Rev
4025.1 FORM CMS-2552-10 11-16 When an inpatient is occupying any other ancillary area (e.g., surgery or radiology) at the census taking hour prior to occupying an inpatient bed, do not record the patient
Rev PARTS I & II TO: PART I - COST REPORT STATUS. 2 ECR Time: 1 ECR Date:
08-14 FORM CMS-1984-14 4390 (Cont.) This report is required by law (42 USC 1395g; 42 CFR 413.20(b)). Completion of this report is viewed as a condition FORM APPROVED of your provider agreement. OMB NO.
Rev PARTS I & II TO: PART I - COST REPORT STATUS. 2 ECR Time: 1 ECR Date:
Attachment A New Hospice Medicare Cost Report Forms 08-14 FORM CMS-1984-14 4390 (Cont.) This report is required by law (42 USC 1395g; 42 CFR 413.20(b)). Completion of this report is viewed as a condition
SNF Consolidated Billing Exclusions/Inclusions
SNF Consolidated Billing Exclusions/Inclusions Under SNF consolidated billing rules, certain Part B services provided to SNF residents are to be billed directly by the SNF. The facility would bill the
UB-92 CONVERSION TABLE - TO BE USED FOR REPORTING NON-INSTITUTIONAL HCSRS
6010.50-M, MAY 1999 DATA REQUIREMENTS CHAPTER 2 ADDENDUM H UB-92 CONVERSION TABLE - TO BE USED FOR REPORTING NON-INSTITUTIONAL HCSRS The revenue codes listed below are authorized by the National Uniform
10-16 FORM CMS (Cont.)
Attachment A New Hospice Medicare Cost Report Schedules 10-16 FORM CMS-1728-94 3290 (Cont.) HOME HEALTH AGENCY REIMBURSEMENT PROVIDER CCN: PERIOD: WORKSHEET S-2-1 QUESTIONNAIRE FROM: FROM: TO: General
05-11 FORM CMS (Cont.)
05-11 FORM CMS-2540-10 4100 4100. GENERAL The Paperwork Reduction Act (PRA) of 1995 requires that the private sector be informed as to why information is collected and what the information is used for
11-16 FORM CMS (Cont.)
11-16 FORM CMS-2552-10 4090 (Cont.) This report is required by law (42 USC 1395g; 42 CFR 413.20(b)). Failure to report can result in all interim FORM APPROVED payments made since the beginning of the cost
MEDICARE WAGE INDEX OCCUPATIONAL MIX SURVEY
MEDICARE WAGE INDEX OCCUPATIONAL MIX SURVEY Date: / / Provider CCN: Provider Contact Name: Provider Contact Phone Number: Reporting Period: 01/01/2016 12/31/2016* Introduction Section 304(c) of Public
VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION
VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION GENERAL INFORMATION Primary Practice Facility Location The type of application being submitted: Please choose facility type (check all that apply):
UB-04/UB-92 Conversion Table - To Be Used For Reporting Non-Institutional TED Records
Chapter 2 TRICARE Systems Manual 7950.2-M, February 1, 2008 TRICARE Encounter Data (TED) Addendum N UB-04/UB-92 Conversion Table - To Be Used For Reporting Non-Institutional TED Records Note: Providers
For Large Groups Health Benefit Single Plan (HSA-Compatible)
Financial Features (DED 1 ) (PBP 2 ) (DED is the amount the member is responsible for before Florida Blue pays) Out-of-Network Inpatient Hospital Facility Services Per Admission (PAD) Coinsurance (Coinsurance
Hospital Outpatient Services Billing Codes Effective January 1, 2018
Hospital Outpatient Services Billing Codes Effective January 1, 2018 Revenue Codes: Codes from the Uniform Billing Editor are used to indicate the various services provided during a hospitalization. For
01-10 FORM CMS (Cont.)
01-10 FORM CMS-2552-96 3690 (Cont.) This report is required by law (42 USC 1395g; 42 CFR 413.20(b)). Failure to report can result in all interim FORM APPROVED payments made since the beginning of the cost
GIC Employees/Retirees without Medicare
GIC Active Employees & Retirees without Medicare 7/1/18 GIC Employees/Retirees without Medicare HMO Summary of Benefits Chart This chart provides a summary of key services offered by your Health New England
Covered Services and Any Limits
WellCare of South Carolina Covered Services and Any Limits Abortions and related Covered only in the case of rape or incest or if the member s life is in danger Allergy testing and treatment Ambulance
RTI Press. Using Medicare Cost Reports to Calculate Costs for Post-Acute Care Claims. Occasional Paper. January 2017
RTI Press Occasional Paper January 2017 Using Medicare Cost Reports to Calculate Costs for Post-Acute Care Claims Nicole M. Coomer, Melvin J. Ingber, Laurie Coots, and Melissa Morley RTI Press publication
A Deep Dive: Your Medicare Cost Report From A-M
Critical Access Hospital and A Deep Dive: Your Medicare Cost Report From A-M September 13, 2017 0 Introduction to Health Care Reimbursement If a non-health care business charges $100 for a good or service
For Large Groups Health Benefit Summary Plan 05301
This is a lower premium plan that offers comprehensive insurance coverage. These plans are designed to help you know your costs upfront with a copayment for the services you use most. Your cost share will
Covered Services and Any Limits
WellCare of South Carolina Covered Services and Any Limits Abortions and related Covered only in the case of rape or incest or if the member s life is in danger Allergy testing and treatment Ambulance
Appendix B: Formulae Used for Calculation of Hospital Performance Measures
Appendix B: Formulae Used for Calculation of Hospital Performance Measures ADJUSTMENTS Adjustment Factor Case Mix Adjustment Wage Index Adjustment Gross Patient Revenue / Gross Inpatient Acute Care Revenue
Place of Service Code Description Conversion
Place of Conversion CMS Place of Code Place of Name The place of service field indicates where the services were performed Possible values include: Code Description Inpatient Outpatient Office Home 5 Independent
KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
MMA Benefits at a Glance
MMA Benefits at a Glance You must get covered services by providers that are part of the Molina plan. You must also make sure that approval is obtained if needed. Ambulance Art Therapy Assistive Care Services
FLEX RETIREE MAP (Over 65 Flex Retirees) 2018 Benefits PROFESSIONAL SERVICES. Visit to a physician, physician assistant or nurse practitioner at a PPG
PROFESSIONAL SERVICES Visit to a physician, physician assistant or nurse practitioner at a PPG Periodic health evaluations/preventive services - Applies when the only service(s) provided is a Medicare
(Cont.) FORM CMS Line 3--This is an institution which meets the requirements of 1861(e) or 1861(mm)(1) of the Act and participate
11-16 FORM CMS-2552-10 4004.1 4004. WORKSHEET S-2 - HOSPITAL AND HOSPITAL HEALTH CARE COMPLEX IDENTIFICATION DATA This worksheet consists of two parts: Part I - Hospital and Hospital Health Care Complex
Place of Service Codes (POS) and Definitions
2950 Robertson Ave, Suite 200 Cincinnati, OH 45209 (P): 513-281-4400 www.medicalreimbursementinc.com www.linkedin.com/company/medical-reimbursement-inc www.twitter.com/medreimburse www.facebook.com/medicalreimbursementinc
All Health Care Salary Survey
2014 All Health Care Salary Survey Executive Summary 8575 164 th Ave NE, Suite 100 Redmond, WA 98052 USA Telephone: 877.210.6563 Fax: 877.239.2457 Email: survey.sales@erieri.com www.salary surveys.erieri.com
Medi-Pak Advantage: Reimbursement Methodology
Medi-Pak Advantage: Reimbursement Methodology The information located on the following pages is intended to summarize the reimbursement methodologies for Medi-Pak Advantage: Medi-Pak Advantage reimburses
Irvine Unified School District ASO PPO /50
An Independent member of the Blue Shield Association Irvine Unified School District ASO PPO 500 90/50 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) THIS
Florida Hospital Uniform Reporting System Version June STATE OF FLORIDA HOSPITAL UNIFORM REPORTING SYSTEM MANUAL June 2018
STATE OF FLORIDA HOSPITAL UNIFORM REPORTING SYSTEM MANUAL 2018-1 June 2018 Table of Contents CHAPTER I REPORTING PRINCIPLES AND INSTRUCTIONS... I-1 INTRODUCTION... I-1 REPORTING REQUIREMENTS... I-1 REPORTING
on how to complete this line if you have a new program for which the period of years is less than Rev. 7
4034 FORM CMS-2552-10 09-15 4034. WORKSHEET E-4 - DIRECT GRADUATE MEDICAL EDUCATION (GME) AND ESRD OUTPATIENT DIRECT MEDICAL EDUCATION COSTS Use this worksheet to calculate each program s payment (i.e.,
Services That Require Prior Authorization
Services That Require Prior Authorization Some of the services listed in the Medical Benefits Chart are covered only if your doctor or other network provider gets approval in advance (sometimes called
Stanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits
Stanislaus County Medical EPO Option The following summary of benefits is a brief outline of the maximum amounts or special limits that may apply to benefits payable under the Plan. For a detailed description
Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members
Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members DEDUCTIBLE (per calendar year) Annual in-network deductible must be paid first for the following services: Imaging, hospital
Appeal Process Information
First-Level Appeals Appeal Process Information Regulation 7 AAC 105.270 stipulates the length of time a provider has to submit a first-level appeal. Most firstlevel appeals must be filed within 180 days
RFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS
The following services are covered by the Indiana Care Select Program. Dual-eligible members, those members eligible for both IHCP and Medicare, will not receive any benefits under Indiana Care Select,
12/7/2017 OVERVIEW. CPAs & ADVISORS
CPAs & ADVISORS experience perspective // CY 2018 OPPS/ASC FINAL RULE & OTHER HEALTHCARE REGULATORY UPDATES Michael K. Westerfield, CPA, FHFMA OVERVIEW CY 2018 OPPC/ ASC Final Rule OPPS payment update
STANDARDS FOR HOSPITALS AND HEALTH FACILITIES: CHAPTER 19 - HOSPITAL UNITS
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Health Facilities and Emergency Medical Services Division STANDARDS FOR HOSPITALS AND HEALTH FACILITIES: CHAPTER 19 - HOSPITAL UNITS 6 CCR 1011-1 Chap 19 [Editor
Summary of Benefits CCPOA (Basic) Custom Access+ HMO
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits CCPOA (Basic) Custom Access+ HMO CCPOA Effective January 1, 2019 HMO Benefit Plan This Summary of Benefits
(2) A renewal certificate of registration as specified in Form 17 shall be valid for one year.
11. Registration and functions of recognized medical institution or hospital.- (1) An application for registration shall be made to the Monitoring Authority as specified in Form 11. The application shall
Covered Services List
CAREPLUS Covered Services List For CeltiCare Health with MassHealth CarePlus Coverage This is a list of all covered services and benefits for MassHealth CarePlus enrolled in CeltiCare Health. The list
The MITRE Corporation Plan
Benefit Type Plan Year Type Calendar Year Annual Medical Out of (for certain services) Employee Employee + 1 Family Annual Prescription Drug Out of Employee Employee + 1 Family Copayments: One copay per
Chapter 7 Inpatient and Outpatient Hospital Care
7 Inpatient & Outpatient Hospital Care ACUTE INPATIENT ADMISSIONS All elective and emergent admissions require prior authorization and/or notification for all Health Choice Generations Member admissions.
Centennial Care Provider Notification Grid
Page 1 of 5 Ablative Procedure for Venous Insufficiency & Varicose Veins Accredited Residential Treatment Center (ARTC) Acute Inpatient Medical (incl. Detoxification services & LTACH)) Acute Inpatient
MEDICARE By Peter G. Pan
Wendell K. Kimura Acting Director Research (808) 587-0666 Revisor (808) 587-0670 Fax (808) 587-0681 LEGISLATIVE REFERENCE BUREAU State of Hawaii State Capitol Honolulu, Hawaii 96813 No. 02-13 October 7,
New Jersey HFMA Preparing Your Occupational Mix Survey
New Jersey HFMA Preparing Your Occupational Mix Survey Presented by: R-C Healthcare Management Services, Inc. K. Michael Webdale Jr., CPA President & CEO Agenda General Overview Occupational Mix background
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services Alcohol, drug, and substance abuse treatment services are provided by the Department of Alcohol and Other Drug Abuse Services
Payment Methodology. Acute Care Hospital - Inpatient Services
Grid Medi-Pak Advantage generally reimburses deemed providers the amount they would have received under Original Medicare for Medicare covered services, minus any amounts paid directly by Original Medicare
AmeriHealth Caritas North Carolina Provider Data Intake Form
AmeriHealth Caritas North Carolina Provider Data Intake Form Section 1 instructions: Please complete all fields below for the provider. Entity name (as written on W9): IPA name (if applicable): Category:
Integrity Accountability Collaboration Trust Respect
S REQUIRING PRIOR AUTHORIZATION Only valid codes will be reviewed. Please refer to CMS/MC guidelines to verify validity. All Hospital Admissions (All Place of service 21 services require authorization.)
Hospital Credentialing Application
Hospital Credentialing Application Thank you for your interest in Superior HealthPlan. Please use this checklist to ensure you have all necessary contract and credentialing items to avoid processing delays.
Florida Medicaid. Outpatient Hospital Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
SITE PROFILE CORNER BROOK
SITE PROFILE CORNER BROOK Western Memorial Regional Hospital 1 Brookfield Avenue P.O. Box 2005 Corner Brook, NL A2H 6J7 709-637-5000 Site Information: Western Memorial Regional Hospital (WMRH), located
Blue Cross Premier Bronze
An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide PPO network including nationwide coverage.
Blue Shield of California
An independent member of the Blue Shield Association City of San Jose Custom ASO PPO 100 90/70 Active Employees Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage
OIG Work Plan Darci Friedman, Director of Regulatory Products Lynne Rinehimer, Sr. Healthcare Solutions Consultant
OIG Work Plan 2014 Darci Friedman, Director of Regulatory Products Lynne Rinehimer, Sr. Healthcare Solutions Consultant Agenda Introduction to, and how to interpret, the OIG Work Plan Review of Hospital
SERVICES REQUIRING PRIOR AUTHORIZATION
S REQUIRING PRIOR AUTHORIZATION All Hospital Admissions (All Place of service 21 services require authorization.) ELECTIVE ADMISSIONS All hospital admissions require review by Gold Coast Health Plan Health
Business-Facts Summary- Healthcare NAICS Summary
- Healthcare NAICS Summary Title Page Title Page Data Version: 2018 Feb (Internal) Report Generation Method: Single Analysis Area: 1789 STATE ST, SAN DIEGO, CA, 92101-2530 Reporting Detail: As Selected
Kaiser Permanente Washington - Pre-Authorization requirements:
Kaiser Permanente Washington - Pre-Authorization requirements: Kaiser Permanente Washington requires pre-authorization for most services to be covered. The information below outlines pre-authorization
Provider Profile GENERAL DETAILS STATE/ PROVINCE: OTHERS (PLEASE SPECIFY): CONTACT DETAILS DESIGNATION NAME PHONE MOBILE
Provider Profile Dear Valued Provider, Kindly fill up this form with the information requested below. Availability of accurate and detailed information about your facility will definitely help QLM staff
2017 Summary of Benefits
H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December
All Indiana Health Coverage Programs Providers. Package C Claim Submission and Coverage Information
P R O V I D E R B U L L E T I N B T 2 0 0 0 0 6 J A N U A R Y 2 0, 2 0 0 0 To: Subject: All Indiana Health Coverage Programs Providers Package C Claim Submission and Coverage Information Overview The purpose
Covered Services List and Referrals and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice
Covered Services Covered Services List and s and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice This chart tells you two things: 1. the covered services and benefits
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare Because you are covered by Medicaid, you pay nothing for covered services. As a Molina Healthcare member, you will continue to receive all medically necessary Medicaid-covered
Medicare Advantage 2014 Precertification Requirements
Medicare Advantage 2014 Precertification Requirements (Effective for Jan 1, 2014 to June 30, 2014) The precertification requirements filed with the Centers for Medicare & Medicaid Services remain in effect
Outpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
PROVIDER PARTICIPATION REQUEST FORM
PROVIDER PARTICIPATION REQUEST FORM Thank you for your interest in becoming a participating provider with Quartz. Your request will be evaluated for participation in all Quartz affiliate networks. In order
Benefit Name In Network Out of Network Limits and Additional Information. N/A Pharmacy. N/A Pharmacy
Excellus BluePPO Drug Coverage Excluded Benefit Time Period: 01/01/2018-12/31/2018 HOBART & WILLIAM SMITH COLLEGES General Information Cost Sharing Expenses Deductible - Single $0 $500 Deductible - Family
Medi-Cal Program. Benefit. Benefits Chart
Chart Please note that the table below is only a summary. More details about benefits can be found in the section of the Medi-Cal Evidence of Coverage booklet. All health care is arranged through your
CLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)
WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 Group Plan PPO Savings Benefit Plan This Summary of Benefits shows the amount you will pay for Covered Services under this
Analysis of State CON Requirements Chart I Does CON apply to acquisition
Alabama Alaska Arkansas To whom does CON apply? No person may acquire, conduct, or operate a new institutional facility ( NIF ) without first obtaining a CON. NIF means: (1) establishment of a new HCF;
Services Covered by Molina Healthcare
Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services
Summary of Benefits Platinum Full PPO 0/10 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Full PPO 0/10 OffEx Group Plan PPO Benefit Plan This Summary of Benefits shows the amount
2012NursingHomeTrendsReport. December20,2013
2012NursingHomeTrendsReport December20,2013 2012 Nursing Home Trends Report Executive Summary BlumShapiro presents the summary of the nursing home trends report for the year ended December 31, 2012, which
MyHPN Solutions HMO Gold 7
MyHPN Solutions HMO Gold 7 HIOS ID: 95865NV0030074 Attachment A Benefit Schedule Calendar Year Deductible (CYD): $3,000 of EME per Member and $6,000 of EME per family. The Calendar Year Out of Pocket Maximum
Schedule of Benefits
Schedule of Benefits ANTHEM Small Business Health Options Program (SHOP) This is a brief schedule of benefits. Refer to your Anthem Certificate of Coverage (Booklet) for complete details on benefits, conditions,
HCPCS Special Bulletin
HCPCS Special Bulletin 2018 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin JANUARY 2018 NO. 13 2018 HCPCS Implementation On January 1, 2018, the Texas Medicaid & Healthcare Partnership
Illinois-Wisconsin HFMA Preparing Your Occupational Mix Survey
Illinois-Wisconsin HFMA Preparing Your Occupational Mix Survey Presented by: R-C Healthcare Management Services, Inc. K. Michael Webdale Jr., CPA President & CEO Agenda General Overview Occupational Mix
All Out-of-Network hospitalizations, surgeries, procedures, referrals, evaluations, services and treatment require prior authorization.
2018 OptumCare Utah Contracted Provider Prior Authorization List Items listed below require prior authorization. Out-of-Network All Out-of-Network hospitalizations, surgeries, procedures, referrals, evaluations,
HEALTH COMMUNITY COLLEGE OF ALLEGHENY COUNTY
HEALTH DEGREE, CERTIFICATE & DIPLOMA PROGRAMS MICHAEL SIMON Associate of Science in Nursing CCAC Class of 2014 Master of Science in Nursing Administration IUP Class of 2018 Nursing Manager Allegheny Health
Data Requirements - Revenue Codes
Chapter 2 TRICARE Systems Manual 7950.2-M, February 1, 2008 TRICARE Encounter Data (TED) Addendum H MAJOR/SUB-CATEGORY 001 Total Charge 001X RESERVED 002X Health Insurance - Prospective Payment System
COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE
COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE This is a list of all covered services and benefits for MassHealth Standard and CommonHealth members enrolled
Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]
![Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]](/thumbs/86/94175655.jpg "Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]")
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx] Group Plan HMO Benefit
CHAPTER 2 ADDENDUM OTHER SPECIAL PROCEDURE CODES M, MAY 1999
6010.50-M, MAY 1999 CHAPTER 2 ADDENDUM E FIGURE 2-E-1 PROCEDURE CODES FOR OUTPATIENT HOSPITAL, AMBULATORY SURGICAL CENTER, BIRTHING CENTER, AND HOSPITAL/OUTPATIENT BIRTHING ROOM CLAIMS Contractors are
Medicare & Medicare Supplemental Insurance (Medigap)
Elder Law Basics Medicare & Medicare Supplemental Insurance (Medigap) Steven A. Kass, Esq., CELA Law Office of Steven A. Kass, PC 105 Maxess Road, Suite N116 Melville, New York 11747 What is Medicare?
JOB TITLES. X Activities Aide/ Rehab Aide X X X X X X. Accounting Manager. Activities Director Activity Therapist Assistant
Arts Accounting Manager Activities Aide/ Rehab Aide Activities Director Activity Therapist Assistant Administrative Asst. Administrative Secretary Administrator Anesthesiologist Assistant Administrator
Summary of Benefits Platinum Trio HMO 0/25 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Trio HMO 0/25 OffEx Group Plan HMO Benefit Plan This Summary of Benefits shows the amount
The Federal Joint Committee (G-BA) and Quality Assurance in Health Care
The Federal Joint Committee (G-BA) and Quality Assurance in Health Care The Hague, 18. November 2010 Dr. Dorothea Bronner Chief Executive Director Federal Joint Committee (G-BA) The Federal Joint Committee
West Virginia Children s Health Insurance Program (WVCHIP) Crystal Fox, Benefit and Eligibility Specialist Fall 2017 Provider Workshop
West Virginia Children s Health Insurance Program (WVCHIP) Crystal Fox, Benefit and Eligibility Specialist Fall 2017 Provider Workshop Annual Income Guidelines for WVCHIP Family Size Medicaid Max WVCHIP
Health Facility Guidelines
Health Facility Guidelines Template - Role Delineation Matrix XYZ Hospital, Abu Dhabi Introduction: Role Delineation refers to a level of service that describes the complexity of the clinical activities
Medicare Cost Report Preparation
Medicare Cost Report Preparation 2552-10 Cost Report March 4, 2016 Copyright, Disclaimer and Terms of Use The material contained within this presentation is proprietary. Reproduction without permission
Select Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES
INTRODUCTION TO THE SUMMARY OF BENEFITS FOR January 1, 2015 - December 31, 2015 Central Alabama and Mobile Area SECTION I INTRODUCTION TO THE SUMMARY OF BENEFITS This booklet gives you a summary of what
IMPACT OF CHANGES TO PROVIDER-BASED HOSPICE MEDICARE COST REPORT SCHEDULES 12/13/2016. Jessica K. Dillard, CPA Consultant
IMPACT OF CHANGES TO PROVIDER-BASED HOSPICE MEDICARE COST REPORT SCHEDULES December 14, 2016 Mark P. Sharp, CPA Partner msharp@bkd.com Jessica K. Dillard, CPA Consultant jdillard@bkd.com 1 TO RECEIVE CPE
Essential Health Benefits Addendum. Office of the Insurance Commissioner Washington State
Essential Health Benefits Addendum Office of the Insurance Commissioner Washington State 1 Details, details Classification of Services Classification of a service may affect the scope of the available