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Minimum Data Set 08/22/96 IDENTIFYING INFORMATION SOURCES FORM HCFA 2552-92 WORKSHEET S-2 AND HCFA RECORDS FIELD NAME F MAN F 17 F 18 F 19 F 20 F 21 F 22 SIZE USAGE X 128 - 128 Subprovider I Title XVIII Payment System P PPS T TEFFA O OTHER 129 - 129 130 - 130 131 - 131 132 - 132 133 - 133 DESCRIPTION LINE S COL S Hospital Title XVIII Payment System Provider Number - Hospital Hospital Name Manual Cost Report Indicator M Manual LOCATION - F 23 F 24...
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How to fill out form hcfa 2552-92 worksheet
Who needs form hcfa 2552-92 worksheet?
Healthcare providers, such as hospitals and skilled nursing facilities, who are seeking reimbursement for their Medicare services.
How to fill out form hcfa 2552-92 worksheet?
01
Start by obtaining the form from the Centers for Medicare and Medicaid Services (CMS) website or through your regional Medicare Administrative Contractor (MAC).
02
Carefully read the instructions provided with the form to understand the required information.
03
Enter the provider's basic information, such as name, address, and provider number.
04
Report the provider's financial data accurately, including cost-to-charge ratio and other relevant financial metrics.
05
Document the patient-specific information, including Medicare numbers, admission and discharge dates, diagnosis codes, and procedure codes.
06
Calculate the appropriate reimbursement amounts based on Medicaid rates and adjustments.
07
Ensure the worksheet is properly signed and dated by the authorized provider representative.
08
Submit the completed form to the MAC or CMS according to the specified deadline.
8.1
Remember to consult with your financial or administrative staff, or seek professional assistance if needed, to accurately complete the form and meet the requirements for reimbursement.
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What is form hcfa 2552-92 worksheet?
Form HCFA 2552-92 is a worksheet used for reporting financial and statistical data by hospitals. It is used to calculate Medicare reimbursement for inpatient services provided by acute care hospitals and critical access hospitals.
Who is required to file form hcfa 2552-92 worksheet?
Acute care hospitals and critical access hospitals that provide inpatient services to Medicare beneficiaries are required to file form HCFA 2552-92 worksheet.
How to fill out form hcfa 2552-92 worksheet?
Form HCFA 2552-92 worksheet can be filled out by following the instructions provided by the Centers for Medicare and Medicaid Services (CMS). The worksheet requires hospitals to report various financial and statistical data, such as patient days, discharges, and revenue information.
What is the purpose of form hcfa 2552-92 worksheet?
The purpose of form HCFA 2552-92 worksheet is to calculate Medicare reimbursement for inpatient services provided by acute care hospitals and critical access hospitals. It helps determine the amount of reimbursement these hospitals are eligible to receive.
What information must be reported on form hcfa 2552-92 worksheet?
Form HCFA 2552-92 worksheet requires hospitals to report various financial and statistical data, including patient days, discharges, total revenue, Medicare revenue, and other financial information.
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