Get the free FORM CMS-2552-96

This document provides a framework for analyzing the costs associated with renal dialysis departments, including direct and indirect expenses, and the allocation of costs for inpatient and outpatient

How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Begin by gathering all necessary financial records for the reporting period.
2. Download the FORM CMS-2552-96 from the official CMS website or obtain a hard copy.
3. Fill out Section A with provider information, including the name, address, and provider number.
4. In Section B, specify the reporting period for which you are filing the form.
5. Complete Section C by entering cost and revenue data from your financial records, ensuring all calculations are accurate.
6. Fill out Section D, detailing various adjustments and related items as prompted.
7. In Section E, address any supplementary questions about your organization and services provided.
8. Review all completed sections for accuracy and completeness.
9. Sign and date the form where indicated to certify the information provided is accurate.
10. Submit the completed form to your Medicare Administrative Contractor (MAC) by the due date.

Who needs FORM CMS-2552-96?

1. Healthcare providers who participate in the Medicare program and need to report cost and reimbursement data.

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.