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How to fill out form cms-2552-96

How to fill out FORM CMS-2552-96

1. Obtain FORM CMS-2552-96 from the CMS website or your local CMS office.
2. Review the instructions on the form carefully before starting.
3. Fill out Part I - Identification of Provider: Include the name, address, and identification number of the facility.
4. Complete Part II - Summary: Provide a summary of overall patient days and costs.
5. Fill out Part III - Allowable Costs: List each cost category that applies to your facility along with the corresponding amounts.
6. Move on to Part IV - Allocation of Costs: Allocate costs appropriately among the different departments or service lines.
7. Fill out Part V - Cost Report Certification: Certify the accuracy of the information provided.
8. Review the entire form for completeness and accuracy.
9. Sign and date the form.
10. Submit the completed form by the specified deadline to the appropriate CMS regional office.

Who needs FORM CMS-2552-96?

1. Healthcare providers such as hospitals, skilled nursing facilities, and rehabilitation centers that participate in Medicare.
2. Facilities seeking reimbursement for services provided to Medicare beneficiaries.
3. Providers that are required to submit cost reports to ascertain allowable costs and reimbursements under Medicare regulations.

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 healthcare providers to report their costs and services to the Centers for Medicare & Medicaid Services (CMS) for reimbursement purposes.

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

Hospitals that bill Medicare for inpatient hospital services and certain other healthcare facilities 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 regarding their operations, fill in the necessary sections of the form accurately, and ensure all calculations are correct, often with assistance from financial professionals.

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

The purpose of FORM CMS-2552-96 is to provide a standardized method for healthcare providers to report their costs, ensuring accurate reimbursement from Medicare for the services they provide.

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

FORM CMS-2552-96 requires reporting of various information including total costs incurred by the facility, revenue generated, patient days, and service-specific costs to ascertain the facility's reimbursement eligibility.