Get the free FORM CMS-2552-96

This worksheet is applicable for short-term acute care hospitals to report costs associated with uncompensated care including charity care and bad debt, as required under Section 112(b) of the Balance

How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Obtain FORM CMS-2552-96 from the CMS website or contact your local Medicare Administrative Contractor.
2. Fill out the provider information section, ensuring accuracy in your name, address, and provider number.
3. Complete the financial data section, where you will report your costs and revenues.
4. Provide detailed explanations for any adjustments or unique circumstances that affect your costs.
5. Review the instructions accompanying the form carefully to ensure compliance with Medicare requirements.
6. Sign and date the form at the bottom where indicated.
7. Submit the completed form to your designated Medicare Administrative Contractor by the specified deadline.

Who needs FORM CMS-2552-96?

1. Healthcare providers that offer services to Medicare patients and are seeking cost-based reimbursement.
2. Organizations that need to report their financial data for accurate Medicare settlement.
3. Providers that operate in home health care, skilled nursing facilities, or other facilities that require cost reports.

People Also Ask about

Can I submit form CMS 1763 online?

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

Can I fax CMS 1763?

Fill out Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance (Form CMS-1763) (PDF) and fax or mail it to your local Social Security office.

Can I submit my Medicare Part B application online?

You can complete your Medicare Part B Enrollment online. You will electronically sign the online application, so you will need to provide an email address.

Can I check my Medicare Part B status online?

Log into (or create) your secure Medicare account. You'll usually be able to see a claim within 24 hours after Medicare processes it. A notice you get after the doctor, other health care provider, or supplier files a claim for Part A or Part B services in Original Medicare.

What is a CMS form?

Medicare Part 2, Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10. This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by clarifying and revising the existing instructions and by revising existing edits. Effective dates vary.

Where do I send my CMS 1763 form?

Send your completed and signed application to your local Social Security office. If you have questions, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

For pdfFiller’s FAQs

What is FORM CMS-2552-96?

FORM CMS-2552-96 is a Medicare cost report used by providers of services to report costs, financial data, and statistics related to providing care to Medicare beneficiaries.

Who is required to file FORM CMS-2552-96?

Providers of services that participate in the Medicare program, such as hospitals and rehabilitation facilities, are required to file FORM CMS-2552-96.

How to fill out FORM CMS-2552-96?

To fill out FORM CMS-2552-96, providers must complete sections detailing various cost categories, gather necessary financial documentation, and ensure all data aligns with Medicare regulations before submission.

What is the purpose of FORM CMS-2552-96?

The purpose of FORM CMS-2552-96 is to determine the reimbursement amount for Medicare services provided, and to establish the costs incurred by the provider in delivering healthcare services.

What information must be reported on FORM CMS-2552-96?

FORM CMS-2552-96 requires reporting of cost data, revenue, patient care statistics, financial statements, and any relevant adjustments or corrections related to Medicare services.