Get the free FORM CMS-2552-96

This form is used by hospitals to report their costs and reimbursements associated with direct graduate medical education (GME) and other medical services under Medicare. It includes detailed calculations

How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Obtain FORM CMS-2552-96 from the official CMS website or your local CMS office.
2. Review the instructions included with the form to understand the requirements.
3. Fill out the identification section with the facility's name, address, and CMS number.
4. Complete the cost reporting section, including financial data required for reimbursement calculations.
5. Provide details on patient care data, including days of service and patient counts.
6. Ensure accuracy in the financial statements and reconcile any discrepancies.
7. Double-check all entries for completeness and correctness.
8. Sign and date the form in the designated section.
9. Submit the completed form to your local Medicare administrative contractor by the deadline.

Who needs FORM CMS-2552-96?

1. Healthcare providers and facilities seeking reimbursement from Medicare for services provided, including hospitals and skilled nursing facilities.

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 the cost report used by Medicare-participating providers to claim costs for services provided to beneficiaries.

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

Hospitals, skilled nursing facilities, and other providers that participate in Medicare are required to file FORM CMS-2552-96.

How to fill out FORM CMS-2552-96?

To fill out FORM CMS-2552-96, providers must gather financial data, expenses, and patient information, then enter this information into the appropriate sections of the form as specified in the instructions provided by CMS.

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

The purpose of FORM CMS-2552-96 is to provide Medicare with the necessary information to determine the costs incurred by providers and to facilitate the reimbursement process.

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

FORM CMS-2552-96 requires reporting of information such as patient demographics, covered services, allowable costs, revenue, and various adjustments related to claims and payments.