2552-10 Hospital
Transmittals
All Transmittal Information for the 2552-10
2552-10 HFS MCRIF32 Approval Letter
Hospital Transmittal 26
The Hospital, 2552-10
system was updated to Transmittal 26 by CMS, on June 30, 2026.
Transmittal 26 is effective for cost
reporting periods ending on or after June 30, 2026.
HFS was approved for Transmittal 26 on July 1, 2026.
The
primary changes in Transmittal 26 were to update the Hospital and Hospital
Health Care Cost Report, Form CMS-2552-10, by clarifying and revising the
existing instructions and revising existing edits.
Revisions include:
·
Worksheet S-2, Part I:
·
Revised instructions for low-volume adjustment
·
Added line 124.01 on worksheet and instructions
for completion of Worksheet S-12, this will be the trigger for completion of
the new Worksheet S-12 effective for cost reporting periods ending on and after
1-1-2026 and the new CMS’ level I edit 16500S.
·
Worksheet S-3, Part II:
·
Revised worksheet and instructions for
clarification for wage index for lines 25.50 through 25.53
·
Worksheet S-3, Part III:
• Revised instructions for line 4 for
clarification of subscripted lines used in the calculation
·
Worksheet S-10:
·
Revised instructions for Exhibit 3B Charity
Care Listing
·
Worksheet D-3:
·
Revised instructions for lines 92 and 92.01 for observation
bed services
·
Worksheet E, Part A:
·
Revised instructions and expiration date for the MDH program
·
Revised instructions for completing Exhibit 4 - Low-Volume
Adjustment Schedule
·
Worksheet E-5:
·
Revised worksheet and instructions for completing Outlier
Reconciliation at Tentative Settlement to include providers paid under the LTCH
PPS
·
Worksheet N-4:
·
Clarified sequestration instructions for line 15
Edits
·
New/Revised Edits: 10450S, 16500S, 10005D,
10010D, 10518D, 10160E, 10161E, 10162E, 10163E, 21310S, 20160A, 20060D
HFS
anticipates updating the Hospital 2552-10 system to T-26 the week of July 6, 2026.
Hospital Transmittal 25
CMS
issued Transmittal 25 to the 2552-10 on February 27, 2026. Transmittal 25
has been issued with effective for cost reporting periods ending on or after December
31, 2025.
Detailed
changes include:
Worksheet
S:
·
Updated expiration date to 9/30/2028
·
Updated hours to complete the forms
·
Worksheet S-12: Added OMB # 0938-1486, Supplemental to
Form CMS-2552-10 toreport the weighted median of the payer-specific negotiated
charges the hospital has negotiated with each Medicare Advantage Organization
(MAO) for each MS-DRG
·
Worksheet D-4, Part IV: Removed shading from line 76,
columns 1, 2 and 3
·
Worksheet L-1, Part I: Corrected instructions for
calculating the unit cost multiplier for line 204, columns 1 through 23
·
Worksheet N-3: Corrected reference to line 4
instructions
·
New Edits: 10510D, 10511D, 10512D, 10513D, 10514D,
10515D, 10516D, 10517D, 10155M
·
Revised Edits: 10450S, 12410S
HFS
received approval for the T-25 on March 11, 2026 and anticipates releasing the
T-25 update the week of March 16th, 2026.
Hospital Transmittal 24
CMS
issued Transmittal 24 to the 2552-10 in September, 2025. Transmittal 24
has been issued with effective for cost reporting periods ending on or after
June 30, 2025. The primary reasons for
the update including changes accommodating Hospital-based RHC/FQHC and CMHC
components for:
-
The elimination of the
productivity Standards
-
Intensive Outpatient
Services
-
Hepatitis B vaccine
reimbursement
Detailed
changes include:
-
Worksheet S-2, Part I:
•
Updated line 39
instructions to extend the effective date of the temporary change in the
low-volume adjustment as provided in 42 CFR 412.101.
•
Added question on line
124 to address establishing and maintaining access to no less than a 6-month
buffer stock of one or more essential medicines.
•
Added question on line
22.05 to identify hospitals receive geographic reclassification for cost
reporting periods ending on or after October 1, 2023.
-
Worksheet S-2, Part II:
•
Clarified instructions
for lines 22 through 40 to be completed only by cost-reimbursed and TEFRA
hospitals.
-
Worksheet S-8:
•
Revised line 12
instructions as productivity standards no longer apply for cost reporting
periods ending after December 31, 2024.
-
Worksheet A:
•
Revised line 92
instructions for observation beds in a Rural Emergency Hospital (REH).
-
Worksheet E, Part A:
•
Updated the effective
dates through 09/30/2025 for Medicare Dependent Hospital (MDH) program.
•
Updated the effective
dates through 09/30/2025 for the temporary change in the low-volume payment
adjustment.
-
Worksheet E-4:
•
Updated line 1
instructions for the unweighted resident FTE count.
-
Worksheets I-2 and I-3:
•
Revised form for column
7.01 to shade cells for Hemodialysis AKI, IPD - AKI, CAPD - AKI and CCPD - AKI.
-
Worksheet I-4:
•
Revised column 2
instructions for transferring ESRD costs.
-
Worksheet I-5:
•
Clarified instructions
for lines 5, 5.01, 5.02, 5.03 and 5.04 for reporting ESRD bad debts.
-
Worksheet M-2:
•
Revised form and
instructions as productivity standards no longer apply for cost reporting
periods ending after December 31, 2024.
-
Worksheet M-3:
•
Revised line 4
instructions for reporting productivity standards.
•
Revised form and
instructions for line 21.60 to include primary payer amounts for IOP services.
-
Worksheet M-4:
•
Revised form and
instructions for reporting Hepatitis B vaccines beginning January 1, 2025, in
column 2.03.
•
Revised form and
instructions for calculating vaccine costs for services on or after July 1,
2025.
HFS
received approval for the T-24 on November 17, 2025 and anticipates releasing
the T-24 update the week of November 17th, 2025.
Hospital Transmittal 23
CMS issued Transmittal 23 to the 2552-10 on December 20th,
2024. Transmittal 23 has been issued with an effective date of Cost Reporting
Periods Beginning on or After October 1, 2024, and implements changes
including:
• Adding OMB #
0938-1473, for the Supplemental to Form CMS-2552- 10 to the Table of Contents
for the Worksheet E-90 - Payment
Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators.
• Worksheet S-2, Part
I, was modified as follows:
o Revised the line
22.03 instructions to include geographic redesignation from urban to rural
under the OMB standards for delineating statistical areas adopted by CMS.
o Revised the line 39
instructions to extend the effective date of the temporary change in the
low-volume adjustment as provided in 42 CFR 412.101.
o Designated
completion of column 8 on Exhibit 3A, Listing of Medicaid Eligible Days for a
DSH Eligible Hospital, as optional.
• Worksheet S-2, Part
II was modified to include revised instructions for reporting the “paidthrough”
dates of the PS&R used to prepare the cost report to include the “Paid
Claims Verified Current As Of” date or the “Paid Dates” from the PS&R used.
And to add lines 15.01 and 15.02 to report home office physician Part A
administrative salaries and contract amounts and sunset line 15.
• Worksheet S-8 was
revised to Clarify the instructions for reporting consolidated RHC groupings.
Worksheet
D-1, Part II, was revised to add line 55.03 to report the CAR T-cell amount
paid for calculating the TEFRA target rate of increase ceiling.
• Worksheet E, Part A,
added line 8.28 to report the awarded FTE cap slots from section 4122 of the
CAA 2023, effective beginning July 1, 2026,In addition revised the line 35.02
instructions to clarify reporting the hospital uncompensated care payment (UCP)
and revised the line 45 instructions to update the CY 2025 ESRD PPS base rate.
In addition, updated the effective dates of the Medicare Dependent Hospital
(MDH) program and the low-volume payment adjustment.
Revised Worksheet
E-4 to add line 4.28 to report the awarded FTE cap slots from section 4122 of
the CAA 2023, effective beginning July 1, 2026 and updated the instructions for
line 29.01 to include the CY 2023 percent reduction to MA DGME.
• Worksheets I-2, I-3,
I-4 were modified to report AKI services.
• Worksheet
M-3instructions were revised for line 21.55 for cost reporting periods ending
on or after January 1, 2024, to report program IOP visits in column 1, and to
calculate the total program IOP services cost for column 2 and revised the instructions for line 21.60
to include reporting deductible amounts for IOP services.
The
T-23 changes were approved by CMS on January 14, 2025, and HFS will update the
Hospital 2552-10 system the week of January 13, 2025.
Hospital Transmittal 22
CMS issued Transmittal 22 to the 2552-10 on February 29th,
2024. Transmittal 22 has been issued
with an effective date of Cost Reporting Periods Beginning on or After October
1, 2023, and implements changes including:
Accommodation for
rural emergency hospitals (REH) claiming medical education costs for interns
and residents effective for portions of cost reporting periods on or after
October 1, 2023, in accordance with FY 2024 IPPS final rule, 88 FR 59053
(August 28, 2023).
Accommodation
for intensive outpatient program (IOP) visits in accordance with the
Consolidated
Appropriations
Act (CAA) of 2023, §4124, effective for services rendered on or after January
1, 2024.
Updated
the MC+GME payment reduction to direct graduate medical education (GME)
for CY 2022.
Revised instructions for Worksheet L to reflect revisions for
providers that underwent a geographic reclassification in accordance with 42
CFR 412.103 per the FY 2024 IPPS final rule, 88 FR 59117 (August 28, 2023).
Revised
M, N and O series instructions to accommodate marriage and family therapists
(MFT) and mental health counselors (MHC), in accordance with the CAA 2023,
§4121.
The
T-22 changes were approved by CMS on March 22, 2024, and HFS will update the
Hospital 2552-10 system the week of April 1st, 2024.
Hospital Transmittal 21
CMS issued Transmittal 21 to the 2552-10 on July 28th,
2023. Transmittal 21 has been issued
with an effective date of Cost Reporting Periods Beginning on or After August
1, 2023, and implements minor changes including:
· The recission of the Community Health
Access and Rural Transformation (CHART) model as of March 17, 2023.
The
addition of edits 14007S, 14008S, 14011S, 14014S, 14016S, and 14021S, to review
S-10 data.
The
T-21 changes were approved by CMS on August 15, 2023, and HFS will update the
Hospital 2552-10 system the week of August 21st, 2023.
Hospital Transmittal 20
CMS issued Transmittal 20 to the 2552-10 on April 21st,
2023. Transmittal 20 has been issued
with an effective date of Cost Reporting Periods Beginning on or After April 1,
2023, and implements minor changes including:
• Revised instructions
to identify and introduce the Rural Emergency Hospital (REH) provider type
effective for cost reporting periods beginning on or after January 1, 2023, as
established by the Consolidated Appropriations Act, 2021, Division H, Title II,
section 125.
• New Level One edit
12975S for cost reporting periods beginning on or after January 1, 2023, to
ensure that REH facilities do not report inpatient days on Worksheet S-3.
• New Level One edit
12980S for cost reporting periods beginning on or after January 1, 2023, to
ensure that REH facilities properly report outpatient visits on Worksheet S-3,
line 15.10.
•
Subsequent to the issuance of T-20 CMS clarified that the
Public Health Emergency (PHE) ended effective May 11,2023.
The
T-20 changes were approved by CMS on June 28, 2023, and HFS will update the
Hospital 255210 system the week of July 3rd, 2023.
Hospital Transmittal 19
CMS
issued Transmittal 19 to the 2552-10 on March 24th, 2023. Transmittal 19 has been issued with an
effective date of Cost Reporting Periods Beginning on or After January 1, 2023
and implements minor changes including:
•
The addition of Worksheet E-95 to provide an IPPS and OPPS
payment adjustment for domestically made N95 surgical respirators for cost
reporting periods beginning on or after January 1, 2023.
•
New Level One edit 10460D for cost reporting periods
beginnings on or after October 1, 2020, to ensure charges billed under revenue
code 0815 are reported on the Worksheet D6 and not on the Worksheet D-3, line
77.
• New Level One edit
10200G to ensure that a description is added for any subscript of Worksheet
G-3, lines 24.51 through 24.60 that contains a dollar amount in column 1.
The
T-19 changes were approved by CMS on April 19, 2023 and HFS will update the
Hospital 255210 system the week of April 17th, 2023.
Hospital
Transmittal 18
• CMS issued
Transmittal 18 to the 2552-10 on December 29th, 2022. Transmittal 18 has been issued with an
effective date of Cost Reporting Periods Beginning on or After October 1, 2022
and implements many of the changes proposed through the PRA process including:
• Addition of Exhibits
for reporting:
o Medicare bad debt by
beneficiary, o Medicaid Eligible
Day for DSH Eligible Hospitals, o Charity care charges by patient.
o Total bad debts by
patient.
• Identification of permanent
adjustments to the TEFRA target amount per discharge.
• Identification of
providers purchasing greater than fifty percent of its professional services
from an unrelated organization located outside the main hospital’s local area
labor market.
• Identification of
the number of temporary expansion COVID-19 public health emergency acute care
beds.
• Revisions to
Worksheet S-10.
• Addition of
Worksheet D-6 Parts I through IV to compute allogeneic HSCT acquisition costs
as required under §1886(d)(5)(M) of the Social Security Act and in accordance
with the statutory requirement under Section 108 of the Further Consolidated
Appropriations Act, 2020 (Pub. L. 116-94) for reasonable cost payment.
• Addition of
Worksheet E-5 for the contractor to report the outlier reconciliation amount
during cost report tentative settlement.
This Transmittal
also implements FY 2023 IPPS final rule changes including DGME changes in
regard to the Hershey litigation effective for cost reporting periods beginning
on or after October 1, 2022. With revisions to Worksheet E-4 and the addition
of Worksheet S-2, Part I, Line 68 to identify cost reports for periods
beginning prior to October 1, 2022, that are eligible for the modified method
of calculating direct GME payments to a teaching hospital when the hospital’s
weighted FTE counts exceed their direct GME FTE cap in accordance with the FY
2023 IPPS final rule
Other
Worksheet E-4 changes have been made to implement Sections 126, 127 and 131 of
the CAA 2021.
This Transmittal also implements changes relating to the
Community Health Access and Rural Transformation (CHART) model. The CHART model is effective for discharges
ending on or after January 1, 2024, for inpatient services, outpatient services,
and CAH swing-bed services.
Other
changes include the extension of the low volume adjustment and the Medicare
Dependent Hospital (MDH) program, but these changes are subject to subsequent
Law provisions.
The
T-18 changes were approved by CMS on February 22, 2023 and HFS will update the
Hospital 2552-10 system the week of March 6th, 2023.
HFS
will be hosting a Hospital 2552-10 Transmittal 18 Overview Webex on March 29,
2023 and registration is available at the below link:
Hospital Transmittal 17
• On January 10, 2022,
CMS published Transmittal 17 to Form CMS-2552-10. The new form CMS-2552-10 T-17
will be effective for cost reporting periods ending on or after December 31,
2021. Please note that this published T-17 does not
reflect all the proposed changes issued in Accordance with the Paperwork
Reduction Act (PRA) issued November 10, 2020. CMS has stated that they are
working on another 30-day comment period for the DRAFT changes which will now
be issued as DRAFT T18, however no specific timeframe has been given. More
information available at: https://www.hfssoft.com/news/.
HFS
was approved for Transmittal 17 on January 21, 2022. Significant changes
include:
• Modifications to the
Worksheet S, Part II, Certification Statement to collect electronic signature
data within the EC file export.
• Removing references
to the term “Nursing School” and replacing them with “Nursing Program”.
• Effective for
services rendered on or after January 1, 2021, include kidneys transplanted
into Medicare Advantage beneficiaries in the count of Medicare usable kidneys
(this does not include non-renal organs, but is limited to kidney) in the
Worksheet D-4, Part III, line 63 count.
• Calculate - Per §2
of the Protecting Medicare and American Farmers from Sequester Cuts Act of
2021, extended the sequestration hold through 3-31-2022.
Transmittal
17 provisions previously incorporated into the software include:
• The addition of
Worksheet S-2, Part I, line 22.04 for “For cost reporting periods ending on or
after October 1, 2020, and before October 1, 2022, The FY 2021 IPPS final rule
(CMS-1735-F;
85
FR 58746, September 18, 2020) provided for a 2 year transition (in accordance
with 42 CFR 412.102) to a rural DSH payment amount from an urban DSH payment
amount, for hospitals that received a geographic reclassification from urban to
rural under the OMB standards for delineating statistical areas adopted by CMS
in FY 2021. Impacted hospitals whose DSH
payment adjustment exceeded 12 percent will receive 2/3 of the difference
between the urban and rural operating DSH for FY 2021 and 1/3 of the difference
between the urban and rural operating DSH for FY 2022. “
• Applicable changes
were also made to the Worksheet E, Part A.
• Instructional
changes on Worksheet A-8-2 primarily impacting CAH reports.
• Worksheets M and N
series (RHC and FQHC) have been updated to account for CMS clarifications for
cost report changes for COVID. Worksheet
M-3 has a change to the label of lines 2 and 3 from vaccines to infections/injections
along with changes for calculation for visits after 4-1-21 to account for cost
limit changes for small Rural RHCs per CR12185.
Worksheets M-4 and N-3 has added columns 2.01 and 2.02 to account for
COVID-19 Vaccines and Monoclonal Antibody Products and a line for COVID-19
injections/infections administered to
MA
enrollees. Worksheet N-1 has added new
lines 48.10 and 48.11 for the cost of COVID-19 Vaccine & Med Supplies along
with Monoclonal Antibody Products.
Worksheet N-4 has a new line 15.25 for sequestration for non-claim based
amounts with line 15 now open for input from PS&R for cost reporting
periods overlapping or beginning on or after May 1, 2020.
HFS
will update the Hospital 2552-10 system the week of January 24th, 2022.
Hospital Transmittal 16
HFS
was approved by CMS for Transmittal 16 on June 12, 2020
▪ HFS to release
Transmittal 16 on June 19, 2020
▪ Effective Date -
Cost Reporting Periods Ending on or After December 31, 2019
The
primary purpose of Transmittal 16 was to incorporate cost reporting changes for
the Pennsylvania Rural Health Model (PARHM) demonstration. Other major changes
include:
▪ Modification of
Worksheet E-4 to accommodate DGME reimbursement for CAHs that train residents
in excluded IPF or IRF units.
▪ Modification to the
calculation of the percentage reduction of the MA direct GME payments for the
calculation of the MA nursing and allied health (NAHE) payment adjustments. The
reductions will be changed on an annual basis using the below factors,
previously the reduction factor was 14.13%
Please note that the new Worksheet S-2, Part I, line 56,
column 2 triggers the above changes to the reduction percentage and references
a Change Request (CR) 11642. That CR was
published on August 21, 2020 and is available at https://www.cms.gov/files/document/r10315OTN.pdf.
▪ Added Worksheet S-3,
Part II – line 16 subscripts for cost reporting periods beginning on or after
10/1/2017 to separately report salaries and wage related costs for home office
and/or related organizations (line 16.01) and contracted Part A teaching (line
16.02).
Hospital Transmittal
15
HFS
was approved by CMS for Transmittal 15 on December 6, 2018
▪ HFS released
Transmittal 15 on December 7, 2018
▪ Effective Date -
Cost Reporting Periods Ending on or After September 30, 2018
This
transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost
Report (Form
CMS-2552-10),
by accommodating select provisions of the Bipartisan Budget Act of 2018, and
the
Fiscal Year (FY) 2019 Inpatient Prospective Payment System
(IPPS) and Long Term Care Hospital (LTCH) PPS Final Rule. This transmittal also
updates Chapter 40 by clarifying and correcting the existing instructions.
Specific
changes include:
▪ Worksheet S-2, Part
I:
▪ Added two new
provider types: Extended Neoplastic Disease Care hospitals and Indian Health
Services hospitals.
▪ Modified the
instructions for line 39 in accordance with the FY 2019 IPPS final rule to
reflect the temporary changes to the low-volume adjustment for the Federal
fiscal year (FFY) 2019 through the FFY 2022, and the changes eliminating the
temporary changes to the low-volume adjustment for the FFY 2023 and subsequent
FFYs.
▪ Wage Index
Clarifications:
▪ Clarified the
instructions for Worksheet S-3, Part II, lines 5, 13, and 14.
▪ Clarified the
instructions to not complete Worksheet S-3, Part II, line 18 for cost reporting
periods beginning on or after October 1, 2018.
▪ Clarified the
instructions for Worksheet S-3, Part IV, line 25 for cost reporting periods
beginning on or after October 1, 2018.
▪ Worksheet D-1:
▪ Clarified the
instructions for line 1 to prevent duplicative counting of non-distinct part
hospice days.
▪ Worksheet E, Part A:
▪ Modified the
instructions to address the use of column 1 where a sole-community hospital
(SCH) experiences a geographic reclassification during the cost reporting
period but remains an SCH for the full cost reporting period.
▪ Modified line 2
instructions and added lines 2.03 and 2.04 for cost reporting periods beginning
on or after October 1, 2018, to separately record outlier payments made for PPS
discharges occurring prior to October 1 and on or after October 1.
▪ Modified the
instructions for line 35.01 to incorporate the uncompensated care Factor 3 calculation
in accordance with the FY 2019 IPPS correction notice.
▪ Modified
instructions for line 90 to include the sum of the original operating outlier
amounts from subscripted lines 2.03 and 2.04.
▪ Worksheets I-2 and
I-3
▪ Added lines 2.01 and
3.01, to capture costs for acute kidney injury (AKI) hemodialysis and AKI
peritoneal dialysis for cost reporting periods ending on or after September 30,
2018.
▪ Worksheet O
▪ Shaded line 25,
column 1.
▪ Worksheet O-3 and
O-4
▪ Shaded line 25,
column 1.
▪ Unshaded line 38,
column 1 through 7.
Hospital Transmittal 14
▪ HFS was approved by
CMS for Transmittal 14 on April 6, 2018
▪ HFS released
Transmittal 14 on April 13, 2018
▪ Effective Date -
Cost Reporting Periods Ending on or After January 31, 2017
This
transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost
Report (Form
CMS-2552-10),
by accommodating select provisions of the Bipartisan Budget Act of 2018, and
the
Fiscal Year (FY) 2018 Inpatient Prospective Payment System
(IPPS) and Long Term Care Hospital (LTCH) PPS Final Rule. This transmittal also
updates Chapter 40 by clarifying and correcting the existing instructions as
well as incorporating additional statutory and regulatory changes.
Specific
changes include:
▪ Worksheet S-2, Part
I:
▪ Modified the
instructions for Worksheet S-2, Part I, line 39 to reflect the extension of the
inpatient hospital adjustment for low-volume hospitals for discharges occurring
through FY 2018.
▪ Clarified the
instructions for Worksheet S-2, Part I, lines 61 – 61.06 as the ACA section
5503 evaluation period requirements expired July 1, 2016.
▪ Worksheet S-3, Part
I:
▪ Opened Worksheet
S-3, Part I, line 33 for the reporting of discharges associated with
non-covered LTCH Medicare days.
▪ Worksheet S-10:
▪ Clarified the
instructions for Worksheet S-10 lines 28 and 29.
▪ Worksheet E, Part A:
▪ Clarified the
instruction for Worksheet E, Part A, line 8.01 as the ACA section 5503
evaluation period requirements expired July 1, 2016.
▪ Updated the instructions
to Worksheet E, Part A, lines 48 and 49 to reflect the extension of the
Medicare-dependent hospital (MDH) program through September 30, 2022, in
accordance with the Bipartisan Budget Act of 2018, §50205.
▪ Worksheet E, Part B:
▪ Clarified the
instructions for E, Part B, line 25 for reporting deductible and coinsurance
amounts for Part B services exempt from the lower of reasonable costs or
customary charges (LCC).
▪ Worksheet E-4:
▪ Clarified the
instruction for Worksheet E-4, line 4.01 as the ACA section 5503 evaluation
period requirements expired July 1, 2016.
▪ Worksheet O and O-1
- O-4:
▪ Added a line 42.50
to report the costs of drugs furnished to individual patients.
Hospital
Transmittal 12/13
▪ HFS was approved by
CMS for Transmittal 12/13 on January 31, 2018
▪ HFS released
Transmittal 12/13 on February 8, 2018
Effective
Date - Cost Reporting Periods Ending on or After September 30, 2017
This transmittal updates Chapter 40, Hospital and Hospital
Health Care Complex Cost Report (Form CMS-2552-10), by including subsection (d)
Puerto Rico providers as eligible for the electronic health record (EHR)
incentive payments and by accommodating the Rural Community Hospital
Demonstration
Project (§410A Demonstration) adjustment. This transmittal also accommodates
the ability for a provider to elect and sign the Certification and Settlement
Summary page of the Medicare cost report using an electronic signature pursuant
to the FY 2018 IPPS Final Rule.
Specific
changes include:
▪ Worksheet S:
▪ Added check box to
the certification and settlement summary statement for electronic signature
submission on cost reporting periods ending on or after December 31, 2017.
▪ Worksheet S-2, Part
I:
▪ Modified
instructions for line 39 to reflect the revised eligibility criteria and
corresponding low-volume adjustment of 25 percent, effective for discharges
occurring on or after October 1, 2017.
▪ Modified
instructions for line 60 for nursing school and allied health education (NAHE)
activities to separately identify each individual program reimbursed in
accordance with the provisions of 42 CFR 413.85 where reimbursement is made on
a reasonable cost basis.
▪ Added lines 98
through 98.06 related to titles V and XIX reimbursement for critical access
hospitals (CAH), reasonable compensation equivalents (RCE), and passthrough
costs. These questions were previously addressed by HFS on a non-CMS Worksheet
S-2. Part IX.
▪ Modified line 110
for the Rural Community Hospital Demonstration Project (also known as the §410A
Demonstration), as extended by §15003 of the 21st Century Cures Act of 2016, to
initiate the calculation of added lines on Worksheet E, Part A, lines 200
through 218, and Worksheet E-2, lines 200 through 215. This calculation was
previously addressed by HFS on non-CMS Worksheet E, Part H.
▪ Added line 111 to
identify providers participating in the Frontier Community Health Integration
Project (FCHIP) Demonstration.
▪ Modified questions
167 and 169 to accommodate subsection (d) Puerto Rico providers eligible for
the electronic health record (EHR) incentive payment for federal fiscal years
2016 through 2021, in accordance with the CCA 2016, Division O, Title VI, §602.
▪ Worksheet S-3, Part
I:
▪ Added line 33.01 to
capture site neutral days and discharges for long term care hospitals (LTCH).
▪ Worksheet A:
▪ Expanded the
instructions for lines 20 and 23 (nursing school and paramedical education)
programs to capture the costs of each program on a separate subscript of line
20 and/or line 23, as applicable.
▪ Added line 77 to
capture allogeneic stem cell acquisition costs as defined in CMS Pub. 100-04,
chapter 4, §231.11.
▪ Added line 93.99 to
capture the costs of providing hospital-based partial hospitalization program
(PHP) services as defined in §1861(ff) of the Act.
▪ Worksheet A-8:
▪ Added instructions
for line 19 to report the nursing school tuition offset adjustment and the
allied health/paramedical education tuition offset adjustment. Note that
tuition offset adjustments are to be made on Worksheet A-8 and not on Worksheet
B-2.
▪ Worksheet B, Part I
and B-1:
▪ Shaded line 116 in
columns 19, 21, and 22. This change prevents the allocation of NonPhysician
Anesthetists and Interns and Residents costs to the hospital-based Hospice.
▪ Worksheet D, Part
III and IV:
▪ Modified the
worksheets by adding post step-down adjustment columns for nursing school and
allied health. Post step-down adjustments were previously accommodated by HFS
using non-CMS columns 11-13 on Worksheet D, Part III and non-CMS columns 21-24
on Worksheet D, Part IV.
▪ Worksheet E, Part A;
E, Part B; E-2, E-3, Parts I through IV; H-4; J-3; M-3; and N-4:
▪ Added two lines to
each reimbursement settlement worksheet to capture demonstration payment
adjustments before sequestration, and demonstration payment adjustments after
sequestration.
▪ Worksheet E, Part A:
▪ Added a dedicated
line 70.50 to capture the 410A demonstration project payment adjustment.
▪ Added lines 200
through 218 to calculate the §410A demonstration project payment adjustment
amount for inpatient services.
▪ Exhibit 4
(Low-volume adjustment):
▪ Modified the
instructions to calculate the low-volume adjustment payment at 25 percent for
services rendered on or after October 1, 2017.
▪ Shaded line 17.01
(net organ acquisition costs), to eliminate it from the low-volume adjustment
payment calculation.
▪ Exhibit 5 (Hospital
acquired condition (HAC) adjustment):
▪ Shaded line 17.01
(net organ acquisition costs), to eliminate it from the HAC adjustment
calculation. ▪
Worksheet
E, Part B:
▪ Added line 4.01 to
capture the operating outlier reconciliation amount for operating expenses
related to outpatient prospective payment (PPS) services.
▪ Worksheet E-1, Part
II:
▪ Modified the
instructions to accommodate the calculation EHR incentive payments for Puerto
Rico subsection (d) hospitals in accordance with CAA 2016, Division O, Title
VI, §602. This worksheet is not completed by original subsection (d) hospitals
for cost reports beginning on or after October 1, 2016.
For additional information regarding the new HFS feature
incorporating the electronic signature click here.
Hospital
Transmittal 11
▪ HFS was approved by
CMS for Transmittal 11 on October 5, 2017
▪ HFS released
Transmittal 11 on November 29, 2017
Effective
Date - Cost Reporting Periods Beginning on or After October 1, 2013
This transmittal clarifies the definitions and instructions
for uncompensated care, non-Medicare bad debt, non-reimbursed Medicare bad
debt, and charity care to include uninsured discounts, as well as modifies the
calculation relative to uncompensated care costs.
Revisions
include:
▪ Worksheet S-10:
▪ Revised the
instructions for line 20 for subsection (d) Puerto Rico hospitals, charity care
and uninsured discounts.
▪ Modified the
calculation and clarified the instructions on line 21, column 2, for insured
patients and non-covered charges for insured patients for days exceeding a
length-ofstay limit.
▪ Clarified the
instructions for line 22.
▪ Clarified that the
amount reported on line 26 is net of recoveries.
▪ Added line 27.01 to
capture Medicare allowable bad debt for the entire facility.
▪ Modified the
instructions for line 28 to only capture the non-Medicare bad debt
expense. ▪ Modified the
calculation for line 29.
Hospital Transmittal 10
▪ HFS was approved by
CMS for Transmittal 10 on January 30, 2017
▪ HFS released
Transmittal 10 on February 3, 2017
▪ Effective Date -
Cost Reporting Periods Beginning on or After October 1, 2015
Transmittal
10 changes include:
▪ Worksheet S-2, Part
I
▪ Added line 171,
column 2, to capture section 1876 Medicare days.
▪ Worksheet S-3, Part
II
▪ Added lines 14.01,
14.02, 25.50, 25.52 and 25.53, to enhance the wage index data collection
effective for cost reporting periods beginning on or after October 1, 2015.
▪ Worksheet S-3, Part
IV
▪ Eliminated the Wage
Index Pension Cost Schedule (Exhibit 3) and the corresponding instructions and
directed providers to use the latest published Wage Index Pension cost Schedule
on the CMS website.
▪ Added lines 8.01,
8.02, and 8.03, to accommodate various categories of health insurance effective
for cost reporting periods beginning on or after October 1, 2015.
▪ Worksheet S-5
▪ Added line 23 to
capture low volume treatments by CNN. ▪ Worksheet S-9,
Parts I-IV
▪ Effective for cost
reporting periods beginning on or after October 1, 2015 AND ENDING on or after
September 30, 2016, hospital-based hospices will no longer complete Parts I and
II, but will complete the new Parts III and IV.
▪ Worksheet S-10
▪ Clarified
instructions for line 20 for the total initial payment obligation of patients
approved for charity care.
▪ Changed the
references to State Children’s Health Insurance Program (SCHIP) to
Children’s Health Insurance Program (CHIP) in the
instructions and on the worksheet.
▪ Worksheet S-11
▪ This new worksheet
captures statistics related to hospital-based FQHCs paid under the FQHC
prospective payment system (PPS) that meet the requirements set forth in 42 CFR
413.65(n). These worksheets supersede Worksheet S-8 for FQHCs only and are
effective for cost reporting periods beginning on or after October 1, 2014.
▪ Worksheet E, Part A
▪ Clarified and
expanded instructions for partial year MDH.
▪ Modified
instructions for line 54 to include in the add-on payment for new technologies
payments associated with Model 4 Bundled Payments for Care Improvement
initiative.
▪ Added line 54.01 to
accommodate the islet isolation transplantation add-on payment effective for
services rendered on or after October 1, 2016, in accordance with CR 9570.
▪ Worksheet E-3, Part
IV
▪ Added lines 1.01
through 1.04 to accommodate new payment categories for Long-Term Care Hospitals
in accordance with the 2016 Inpatient Prospective Payment System final rule
effective for discharges in cost reporting periods beginning on or after
October 1, 2015.
▪ Worksheet E-4
▪ Added lines 10.01,
15.01, and 16.01, to accommodate unweighted resident FTE counts. These amounts
are used to reconcile with amounts in the Intern and Resident Information
system (IRIS) and do not impact the settlement summary.
▪ Revised instructions
for lines 42 and 43 to reflect Part B reasonable costs and the primary payer
amounts, for provider-based FQHCs completing the Worksheet N series.
▪ Worksheet I-1
▪ Modified
instructions for line 10 through 16, revising the effective date for line 15
(Drugs) to cost reporting periods beginning
on or after October 1, 2015, to capture Erythropoiesis stimulating agents
(ESA).
▪ Modified
instructions for line 27 (Subtotal) to reflect the applicable reconciliation to
Worksheet B, Part I, for cost reporting periods beginning prior to October 1,
2015 and on or after October 1, 2015.
▪ Worksheet I-2 and
I-3
▪ Clarified
instructions for lines 14 and 15 to include all ESA costs on line 14 for cost
reporting periods beginning on or after October 1, 2015.
▪ Worksheet M series
▪ Modified
instructions to convey that the Worksheet M series no longer applies to
hospital-based FQHCs, effective for cost reporting periods beginning on or
after October 1, 2014. However, hospital-based rural health clinics still
complete the “M” worksheet series.
▪ Worksheet M-1: Added
new cost centers for telehealth and chronic care management.
▪ Revised forms and
instructions to comply with the regulations at 42 CFR 413.78(a), to ensure that
no separate graduate medical education (GME payment is calculated for the
hospital-based RHC or FQHC.
▪ Worksheet N series
▪ Effective for cost
reporting periods beginning on or after October 1, 2014, hospitalbased FQHCs
complete the new Worksheet N series and are reimbursed under the FQHC
prospective payment system.
Worksheet
K series
▪ Modified
instructions to reflect that the Worksheet K series no longer applies to
hospitalbased hospices effective for cost reporting periods beginning on or
after October 1, 2015 AND ENDING on or after September 30, 2016.
▪ Worksheet O series
▪ Effective for cost
reporting periods beginning on or after October 1, 2015 AND ENDING on or after
September 30, 2016, hospital-based hospices complete the new Worksheet O
series.
Hospital
Transmittal 9
▪ HFS was approved by
CMS for Transmittal 9 on 6/15/2016
▪ HFS released
Transmittal 9 on 3/18/2016
▪ Effective Date -
Cost Reporting Periods Ending on or After October 1, 2015
Transmittal
9 changes include:
▪ Addition of
Worksheet S-2, Part I, line 37.01 and instructional changes to Worksheet E,
Part A, to implement special payment provisions for Medicare-Dependent, Small
Rural Hospitals (MDH) eligible for transitional hospital-specific payments. The
November 13, 2015, Outpatient PPS Final Rule identified 8 MDH hospitals that
were re-designated as Urban based on the adoption, of the new OMB delineations,
however did not qualify to apply for rural status. These hospitals will qualify
for a transitional HSP payment as follows:
▪ Discharges 1/1/2016
– 9/30/2016 – Federal rate plus two-thirds of 75% of the amount by which the
Federal rate payments is exceeded by the HSR
▪ Discharges 10/1/2016
– 9/30/2017 – Federal rate plus one-third of 75% of the amount by which the Federal
rate payments is exceeded by the HSR
▪ Worksheet S-2, Part
I, line 122 was added to identify cost reports that contain “state health or
similar
taxes” and the location of those taxes on Worksheet A.
Hospital
Transmittal 8
▪ HFS was approved by
CMS for Transmittal 8 on 10/26/2015
▪ HFS released
Transmittal 8 on 11/18/2015
▪ Effective Date -
Cost Reporting Periods Ending on or After June 30, 2015
The
major changes clarify and correct the existing instructions and incorporate statutory
and regulatory changes. Revisions include:
▪ Worksheet S-2, Part
I, line 87 was added to identify hospitals classified as “subclause (II)” long
term care hospitals (LTCHs) as described at 42 CFR 412.526(c). This is a
special Legislative provision impacting one LTCH that will receive a TEFRA-type
settlement.
▪ Worksheet S-2, Part
I, line 145, column 2, was added to identify providers that have an ESRD unit
with no Medicare utilization.
▪ Worksheet S-2, Part
I, line 168.01 was added to identify critical access hospitals that qualify for
a hardship exception under 42 CFR 413.70(a)(6)(ii). CAH providers that are not
a meaningful user
of
EHR and did not qualify for a hardship exception, will receive reimbursement
penalties starting with cost reporting periods beginning in Federal Fiscal Year
2015.
▪ Worksheet L, Part I,
was modified to provide for a partial year capital DSH payment for hospitals
that were re-designated from Urban to Rural and a result of the CBSA
re-designations on 10/1/2014.
▪ Due to the
implementation of a revised PPS effective for cost reporting periods beginning
on or after October 1, 2014, CMS has proposed a new cost report N series for
hospital-based FQHC units. The FQHC will be required to file the new cost
reporting worksheets when CMS makes them available.
HFS
will be distributing the 2552-10, Transmittal 8 to all hospital software users
in the November 6, 2015 update.
Hospital
Transmittal 7
▪ HFS was approved by
CMS for Transmittal 7 on 4/1/2015
▪ HFS released
Transmittal 7 on 4/3/2015
▪ Effective Date -
Cost Reporting Periods Ending on or After October 1, 2014
The
major changes reflect Federal Fiscal Year 2015 IPPS Final Rule changes include:
▪ The addition of
Worksheet S-2, Part I, lines 22.02 and 22.03 to identify newly merged hospitals
and hospitals that undergo an involuntary reclassification from Urban to Rural.
▪ The addition of
Worksheet-2, Part I, line 40, to identify hospitals that are subject to the
Hospital Acquired Condition (HAC) reduction adjustment.
▪ The addition of
Worksheet E, Part A, lines 22.01, 28.01 and 29.01 to compute the IME adjustment
for managed care patients in a teaching hospital and revision to line 49 to add
in the IME adjustment amount for managed care patients effective for cost
reporting periods beginning on or after October 1, 2014.
▪ Instructional
revisions to Worksheet E, Part A lines 35, 35.01 and 35.02 to calculate
uncompensated care for newly merged hospitals in accordance with the 2015 IPPS
Final Rule and Sole Community Hospitals that do not have a hospital
uncompensated care payment amount determined by CMS.
▪ The addition of
Worksheet E, Part A, lines 70.90, 70.91, and 100 through 104 to compute the
value based purchasing adjustment amount and the hospital readmissions
reduction adjustment amount for Medicare Dependent Hospitals that receive a
hospital specific bonus payment amount.
▪ Instructional
revisions to Worksheet E, Part A, line 34 for hospitals that undergo an
involuntary reclassification from Urban to Rural as a result of CMS’ adoption
of new standards for delineating new statistical areas.
▪ The addition of
Worksheet E, Part A, line 70.99 and Exhibit 5 to reconcile the HAC reduction
adjustment amount in accordance with the §3008 of the Patient Protection
Affordable Care Act (ACA) of 2010.
Other
changes include:
▪ The addition of
Worksheet S-2, Part I, lines 81, 110 and 171 to identify long term care
hospitals that are co-located in another hospital, hospitals that participate
in the 410A Demo and hospitals claiming Medicare days for individuals enrolled
in 1876 Medicare cost plans.
▪ Modified Worksheet
E, Part A, lines 1.02, 1.03 and 1.04 to always split Medicare payments for IPPS
services at October 1 of each Federal Fiscal year.
▪ Clarified
instructions to Worksheet E-4, lines 2, 8 and 15 for Direct Graduate Medical
Education (GME) FTEs.
▪ Revisions to
Worksheets E, Part A; E, Part B; E-2; E-3, Parts I through VI; H-4; J-3; and
M-3 to add lines for the Pioneer Accountable Care Organization demonstration
payment adjustment in accordance with section 3022 of the ACA, effective for
discharges occurring on or after April 1, 2014.
2552-10 T-7 Cost Report Update
Hospital
Transmittal 6
▪ HFS was approved by
CMS for Transmittal 6 on 10/22/2014
▪ HFS released
Transmittal 6 on 11/3/2014
▪ Effective Date -
Cost Reporting Periods Ending on or After June 30, 2014
Major
Medicare provisions incorporated by Transmittal 6 include:
▪ Changes were made to
Worksheet S-2 and Worksheet D-4 eliminating the "other" organ
transplant category from the Worksheets and check box selections.
▪ Worksheets S-2, D
Part III, D Part IV and E-3 Part V, were clarified to address new children’s
and new cancer hospitals. A new TEFRA provider will be reimbursed as “Other” in
its first year prior to the establishment of a TARGET rate.
▪ CMS modified the
calculation of teaching physician costs on the Worksheet D-5 by adding Parts
III and IV. Parts III and IV will replace the previous Worksheet D-5, Parts I
and II and will apply the RCE calculations to the teaching physician salaries,
similar to the methodology used on Worksheet A-8-2.
▪ Worksheet E, Part A
and the Exhibit 4 instructions were modified to address the extension of the
MDH designation and Low Volume Adjustment, through March 31, 2015.
▪ Line 41.01 was added
to Worksheet E, Part A, to report ESRD Medicare covered and paid discharges.
While line 41 (ESRD Medicare Discharges) will be retained and used to compute
the 10% qualifying criteria for the ESDR additional payment, line 41.01 will be
used to compute the actual adjustment amount.
Hospital
Transmittal 5
▪ HFS was approved by
CMS for Transmittal 5 on 3/31/2014.
▪ HFS released
Transmittal 5 version 5.0.153.2 on 4/3/2014.
▪ Effective Date –
“Cost Reporting Periods Overlapping or Beginning on or After October 1, 2013.”
▪ Model 4 bundled
payments for care improvement (BPCI) initiative but paid outside of the bundled
payment in accordance with ACA 2010, section 3023
▪ Update of the low
income patient (LIP) adjustment factor and update of the teaching adjustment
factor
▪ Include Medicare
labor and delivery days in the calculation of the Medicare patient load ratio
used to apportion direct graduate medical education payments in accordance with
the Federal Fiscal Year (FFY) 2014 IPPS final rule
▪ Implement
calculation of Uncompensated Care Payments ▪ Minor provisions
effective earlier
▪ Corrected
instructions for lines 71 and 72, medical supplies charged to patients and
implantable devices charged to patients, respectively.
▪ Added line 39.98 to
reflect partial or full credits received from manufacturers for replaced
devices.
HFS T.5 Changes Power Point Presentation
HFS Recorded T.5 Changes Webinar
Links to source data
for PowerPoint slides
Hospital
Transmittal 4
▪ HFS was approved by
CMS for Transmittal 4 on 11/08/2013.
▪ HFS posted
Transmittal 4 version 4.1.149.1 on 11/16/2013.
▪ T-4 is effective for
cost reporting periods beginning on or after 10/01/2012. ▪ Some provisions effective earlier
▪ Sequestration
effective for services 4/1/2013
▪ Bad Debt reductions
effective FYB 10/1/2012
▪ ESRD PPS effective
FYE on or after 1/1/2011
▪ ACA Section 5503
I&R changes effective FYE on or after 7/1/2011
HFS T.4 Changes Power Point Presentation
HFS Recorded T.4 Changes Webinar
Hospital
Transmittal 3
▪ HFS was approved by
CMS for Transmittal 3 on 11/27/2012.
▪ CMS required
additional changes before HFS could release the approved T.3 software.
▪ HFS posted version
3.1.135.0 on 12/6/2012.
▪ T-3 is effective for
cost reporting periods ending on or after 6/30/2012.
▪ MAC’s can accept
reports submitted on Transmittal 2, with an FYE of 6/30/2012, but MUST settle
on Transmittal 3.
▪ T.3 was “finalized”
on 12/7/2012, so all 6/30/2012 FYE and after, submitted on or after 12/7/2012,
MUST be filed on T.3 (version 3.1.135.1 or later).
HFS
T.3
Changes
Power
Point
Presentation
HFS Recorded T.3 Changes Webinar