Get the free FORM CMS-2552-96

This form is utilized for the calculation of a hospital's average hourly wage and for maintaining statistical records required under federal regulations for hospital-based home health agencies. It

How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Gather all necessary financial documents and data related to your healthcare facility.
2. Download FORM CMS-2552-96 from the CMS website or obtain a physical copy.
3. Fill out the general information section, including the facility name and address.
4. Complete Part I: Provider Information, detailing ownership and organizational structure.
5. Fill out Part II: Cost Reporting Data, including the various cost reports related to patient care.
6. Enter Medicare-specific data in Part III: Medicare Cost Report Information.
7. Complete Part IV: Provider Operation Costs, ensuring that all expenses are detailed and categorized correctly.
8. Use Part V to summarize and calculate total costs and adjustments.
9. Review all completed sections for accuracy and completeness.
10. Sign and date the certification page at the end of the form.
11. Submit the completed form to your Medicare Administrative Contractor (MAC) by the specified deadline.

Who needs FORM CMS-2552-96?

1. Healthcare providers who seek reimbursement from Medicare for services provided to patients.
2. Hospitals and long-term care facilities that participate in Medicare programs.
3. Facilities requiring cost reporting to ensure compliance with federal regulations.

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 cost report used by hospitals and certain types of healthcare providers to report their costs and determine reimbursement from Medicare.

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

Providers that participate in Medicare and provide inpatient hospital services 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 collect financial data, complete the form's sections accurately, and ensure that all required financial statements and supporting documentation are included.

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

The purpose of FORM CMS-2552-96 is to collect financial information from hospitals so that Medicare can calculate the appropriate reimbursement based on allowable costs.

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

FORM CMS-2552-96 requires providers to report information including total costs, revenues, patient care statistics, administrative expenses, and details of services rendered.