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3530.2 FORM CMS 254096 0203 Column 9. Extend the net allowable Part B costs from column 5 less the reduction amounts in column 8, for lines 25, 26, and 27. Multiply the indicated title XVIII, Part

How to fill out 35302 form cms 2540-96

How to fill out 35302 form cms 2540-96:

1. Start by filling out the top section of the form, which includes the facility name, address, and provider number.
2. Next, provide the name of the fiscal intermediary or Medicare administrative contractor (MAC) and the contact information.
3. In Section 1, provide the period covered by the report and the certification type.
4. Fill out Section 2, which includes the Medicare utilization categories and the associated patient days and charges for each category.
5. In Section 3, report the hospital statistics, such as the total beds available, average daily census, and total discharges.
6. Complete Section 4 by documenting any special information or circumstances that may affect the cost report.
7. Section 5 requires the facility to report specific Medicare cost data, such as skilled nursing facility costs, rural health clinic costs, and home health agency costs.
8. In Section 6, provide additional notes or explanations if necessary.
9. Finally, sign and date the certification statement in Section 7 to validate the accuracy of the information provided.

Who needs 35302 form cms 2540-96:

1. Hospitals and healthcare facilities that receive Medicare reimbursement need to fill out the 35302 form cms 2540-96.
2. This form is required by the Centers for Medicare and Medicaid Services (CMS) to collect cost data and determine appropriate reimbursement levels.
3. It is particularly relevant for hospitals and healthcare facilities seeking Medicare reimbursement for their services.

For pdfFiller’s FAQs

What is 35302 form cms 2540-96?

35302 form cms 2540-96 is a form used by healthcare facilities to report their financial and statistical data to the Centers for Medicare & Medicaid Services (CMS).

Who is required to file 35302 form cms 2540-96?

Hospital and healthcare facilities that receive Medicare or Medicaid reimbursement are required to file 35302 form cms 2540-96.

How to fill out 35302 form cms 2540-96?

35302 form cms 2540-96 can be filled out electronically or manually following the instructions provided by CMS. It requires financial and statistical data such as revenue, expenses, patient days, etc.

What is the purpose of 35302 form cms 2540-96?

The purpose of 35302 form cms 2540-96 is to collect data from healthcare facilities to monitor healthcare costs, quality of care, and to determine reimbursement rates for Medicare and Medicaid.

What information must be reported on 35302 form cms 2540-96?

Information such as revenue, expenses, patient days, patient demographics, services provided, staffing levels, etc. must be reported on 35302 form cms 2540-96.

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