Get the free FORM CMS-2552-96

This form is used for reporting costs and reimbursement settlement for outpatient radiology services provided by hospitals. It includes calculations for reasonable cost versus customary charges and

How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Obtain FORM CMS-2552-96 from the official CMS website or your local Medicare Administrative Contractor.
2. Fill out the provider's basic information at the top of the form, including facility name, address, and Medicare number.
3. Complete the specific sections applicable to your facility type, such as general information, financial data, and cost reports.
4. Input all required cost and statistics data as per the guidelines provided in the form instructions.
5. Review each section for accuracy and ensure all necessary signatures are included.
6. Submit the completed form along with any required documentation to the appropriate Medicare Administrative Contractor by the due date.

Who needs FORM CMS-2552-96?

1. Healthcare providers and facilities that participate in Medicare and need to report costs and statistics.
2. Organizations seeking reimbursement for services rendered to Medicare patients.
3. Facilities such as hospitals, skilled nursing facilities, and other institutional providers.

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 swing-bed hospitals to report their costs and calculate their Medicare reimbursement.

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

Skilled nursing facilities and swing-bed hospitals that provide services under Medicare 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 follow the instructions provided by CMS, which include completing various sections detailing costs, revenue, and patient statistics.

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

The purpose of FORM CMS-2552-96 is to determine the allowable costs incurred by facilities in providing Medicare services and to calculate reimbursement amounts from Medicare.

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

FORM CMS-2552-96 requires reporting of financial data, including total costs, revenue from services, patient days, and various adjustments necessary for Medicare calculations.