Get the free FORM CMS-2552-96

This form is used to calculate reimbursement settlements for outpatient services provided by hospitals and ambulatory surgical centers, detailing methodologies for cost reporting, reimbursement, 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 Centers for Medicare & Medicaid Services (CMS) website or your local Medicare office.
2. Fill out the identification section, including the provider name, address, and Medicare provider number.
3. Complete Section A: Provider Information, ensuring accurate and up-to-date details.
4. Fill in the cost report period dates in Section B.
5. Complete the Schedule of Statistics in Section C to provide necessary operational statistics.
6. Report your financial information in Section D, including revenue and expense categories.
7. Fill out all applicable sections related to specific cost allocation in Sections E through N.
8. Review the certification and signature area to ensure it's signed by an authorized representative.
9. Attach any required supporting documentation as indicated in the instructions.
10. Submit the completed FORM CMS-2552-96 to the appropriate Medicare Administrative Contractor (MAC) by the deadline.

Who needs FORM CMS-2552-96?

1. Healthcare providers that participate in Medicare and seek reimbursement for services rendered need FORM CMS-2552-96.
2. Institutions such as skilled nursing facilities, hospitals, and certain outpatient providers must fill out this form for cost reporting purposes.

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 Medicare-certified institutional providers like hospitals and skilled nursing facilities to report their costs of providing services.

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

Medicare-certified institutional providers, such as certain hospitals and 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, providers must gather financial data based on their accounting records, follow the specific instructions for each section of the form, and ensure accurate calculations of costs associated with providing services.

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

The purpose of FORM CMS-2552-96 is to determine the reasonable cost of services provided to Medicare beneficiaries and to ensure proper reimbursement for those services.

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

Information that must be reported on FORM CMS-2552-96 includes patient service costs, overhead costs, statistical data related to patient care, and any adjustments to costs as necessary for accurate reporting.