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10-12 FORM CMS-2552-10 ALLOCATION OF GENERAL SERVICE COSTS TO HHA COST CENTERS STATISTICAL BASIS HHA COST CENTER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 4090 (Cont.) PROVIDER CCN:
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Begin by reading the instructions provided with the form to understand the specific requirements and guidelines for completing it.
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Gather all the necessary information and documentation required for the form, such as financial statements, cost reports, and any supporting documents.
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Start by filling out the basic information section of the form, including the facility name, address, and provider number.
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Proceed to the financial information section and provide accurate information regarding the facility's revenue, expenses, and costs for the specified time period.
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Make sure to include any necessary explanations or clarifications in the designated areas of the form.
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Who needs 10-12 form cms-2552-10 4090:
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Healthcare facilities or organizations that receive Medicare reimbursements for services rendered.
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Specifically, providers or suppliers seeking reimbursement through the Medicare Cost Report program would need to fill out form cms-2552-10 4090.
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This form is typically required for healthcare facilities such as hospitals, skilled nursing facilities, home health agencies, and hospices.
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