Get the free FORM CMS-2552-96

This worksheet provides for the collection of hospital wage data which is needed to update the hospital wage index applied to the labor-related portion of the national average standardized amounts

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.
2. Read the instructions carefully to understand the requirements for filling out the form.
3. Begin by entering the basic facility information in Section A, including the name, address, and Medicare provider number.
4. Fill out Section B by providing details on the reporting period and type of cost report.
5. Complete Section C by detailing the financial data, including costs associated with patient care and administrative expenses.
6. In Section D, input information related to your facility's ownership and any related entities.
7. Review Section E for any applicable adjustments and additional schedules that may need to be filled out.
8. Ensure all financial information is accurate and matches supporting documents.
9. Sign and date the certification section of the form.
10. Submit the completed FORM CMS-2552-96 to your designated Medicare Administrative Contractor (MAC) by the required deadline.

Who needs FORM CMS-2552-96?

1. The FORM CMS-2552-96 is needed by Medicare-certified hospitals and other healthcare facilities to report their costs and provide necessary financial data for reimbursement.

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, home health agencies, and hospice organizations participating in the Medicare program to report their costs and determine reimbursement rates.

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

Skilled nursing facilities and other healthcare providers participating in Medicare are required to file FORM CMS-2552-96 to report their costs for the reimbursement process.

How to fill out FORM CMS-2552-96?

To fill out FORM CMS-2552-96, providers must gather financial data related to their operations, including costs, revenues, and patient care statistics, and input this information into the required sections of the form as per the instructions provided by CMS.

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

The purpose of FORM CMS-2552-96 is to collect necessary financial data from Medicare providers to ensure appropriate reimbursement for services provided to beneficiaries and to maintain cost accountability.

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

Providers must report various types of information on FORM CMS-2552-96, including total operating costs, direct and indirect patient care costs, facility revenues, and statistical data on patient care services.