Get the free FORM CMS-2552-96

This form is used for reporting costs associated with hospital inpatient services, including the apportionment of capital costs, ancillary service costs, and routine service costs as mandated by Medicare

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 your local Medicare office.
2. Read the instructions provided with the form carefully.
3. Begin by filling out the basic information section, including the name and address of the facility.
4. Enter the fiscal year end date for which you are reporting.
5. Complete Section II to provide the cost report data, including assets, liabilities, revenues, and expenses.
6. Fill out the relevant schedules as per the services offered by the facility based on instructions.
7. Review the cost report for accuracy and completeness.
8. Obtain necessary signatures from authorized individuals at your facility.
9. Submit the completed form to the appropriate Medicare Administrative Contractor (MAC) by the deadline.

Who needs FORM CMS-2552-96?

1. Healthcare facilities that provide services to Medicare beneficiaries and need reimbursement for costs incurred.
2. Providers of inpatient and outpatient services, including hospitals and skilled nursing facilities.

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 skilled nursing facilities and certain other providers to report their costs and patient data to the Centers for Medicare & Medicaid Services (CMS).

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

Skilled nursing facilities that participate in the Medicare program are required to file FORM CMS-2552-96.

How to fill out FORM CMS-2552-96?

To fill out FORM CMS-2552-96, facilities must gather their financial records and patient data, complete sections related to costs, revenue, and patient statistics, and ensure that all provided information is accurate and in compliance with CMS instructions.

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

The purpose of FORM CMS-2552-96 is to determine the amount of Medicare reimbursement a skilled nursing facility is entitled to by documenting its costs and financial performance.

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

FORM CMS-2552-96 requires reporting of financial information such as total costs, revenues, patient days, and other operational statistics essential for calculating reimbursement.