2552-10 Hospital Transmittals
All
Transmittal Information for the 2552-10
2552-10 T-25 HFS MCRIF32 Approval Letter
2552-10 T-25 from CMS Website
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 to report 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:
Register form (webex.com)
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.
2552-10 T-8 from CMS Website
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 from CMS Website
2552-10 T-7 Recorded Webinar
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