Get the free FORM CMS-2552-96

This form is used to allocate general service costs to various outpatient rehabilitation provider cost centers, capturing detailed expenses and allocations for different types of services provided.

How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Obtain FORM CMS-2552-96 from the Medicare website or your local Medicare office.
2. Review the instructions provided with the form to understand the requirements.
3. Fill out the provider information section, including the name, address, and provider number.
4. Complete the financial data section, ensuring accuracy in reporting both revenue and expenses.
5. Include any necessary supporting documentation, such as cost reports and verification of expenses.
6. Review the filled-out form for completeness and accuracy before submission.
7. Submit FORM CMS-2552-96 to your Medicare contractor by the specified due date.

Who needs FORM CMS-2552-96?

1. Organizations that provide inpatient hospital services and seek reimbursement from Medicare.
2. Any healthcare providers that need to report costs associated with providing Medicare services.

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 providers to report the costs of services provided to Medicare beneficiaries.

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

Medicare-participating hospitals and certain other Medicare providers are required to file FORM CMS-2552-96.

How to fill out FORM CMS-2552-96?

To fill out FORM CMS-2552-96, providers need to gather their financial data, complete the required sections, ensuring accuracy in reporting costs and revenues, and submit it by the established deadlines.

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

The purpose of FORM CMS-2552-96 is to determine the allowable costs incurred by Medicare providers and to calculate reimbursements from Medicare.

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

The information that must be reported on FORM CMS-2552-96 includes patient services, operating expenses, non-operating expenses, cost allocation methods, and revenue data.