Get the free MHSA Adjustments Worksheet - DHCS - CA.gov

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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYDepartment of Health Care ServicesDHCS 1822 A (02/19)Annual Mental Health Services Act (MESA) Revenue and Expenditure Report Fiscal Year: FY 202223

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How to fill out mhsa adjustments worksheet

01

Gather all financial information related to Mental Health Services Act (MHSA) funding.

02

Review the MHSA adjustments worksheet template provided by the funding agency.

03

Fill out the worksheet with accurate and up-to-date information, including any adjustments or corrections needed.

04

Double-check all calculations and ensure that the final figures are correct.

05

Submit the completed MHSA adjustments worksheet to the appropriate person or department for review and approval.

Who needs mhsa adjustments worksheet?

01

Government agencies responsible for distributing MHSA funding

02

Mental health service providers receiving MHSA funding

03

Financial officers or accountants overseeing MHSA funds

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What is mhsa adjustments worksheet?

The mhsa adjustments worksheet is a form used to calculate and report adjustments made to the Medicare High Cost Outlier (HCO) payments.

Who is required to file mhsa adjustments worksheet?

Healthcare providers who have been approved for Medicare High Cost Outlier payments are required to file the mhsa adjustments worksheet.

How to fill out mhsa adjustments worksheet?

The mhsa adjustments worksheet should be filled out by entering the necessary information such as patient details, cost information, and specific adjustments made.

What is the purpose of mhsa adjustments worksheet?

The purpose of the mhsa adjustments worksheet is to ensure accurate reporting and calculation of Medicare High Cost Outlier payments.

What information must be reported on mhsa adjustments worksheet?

The mhsa adjustments worksheet requires reporting of patient information, cost details, and any adjustments made to the Medicare High Cost Outlier payments.

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