Outpatient Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

Chapter 18

OUTPATIENT REHABILITATION PROVIDER COST REPORT

FORM CMS-2088-92

Section

General. 1800

Rounding Standards for Fractional Computations 1800.1

Recommended Sequence for Completing Form CMS-2088-92. 1801

Worksheet S - Outpatient Rehabilitation Provider Cost Report. 1802

Part I - Identification Data 1802.1

Part II - Certification by Officer or Administrator of Provider(s) 1802.2

Part III - Settlement Summary 1802.3

Part IV - Outpatient Rehabilitation Provider Statistical Data 1802.4

Worksheet S-1 - Analysis of Payments to Outpatient Rehabilitation Providers for

Services Rendered to Program Beneficiaries. 1803

Worksheet A - Reclassification and Adjustment of Trial Balance of Expenses. 1804

Worksheet A-1 - Reclassifications. 1805

Worksheet A-3 - Adjustments to Expenses. 1806

Supplemental Worksheet A-3-1 - Statement of Costs of Services From Related

Organizations. 1807

Worksheet B - Cost Allocation - General Service Costs and Worksheet B-1 -

Cost Allocation - Statistical Basis. 1808

Worksheet C - Apportionment of Patient Service Costs. 1809

Worksheet D - Calculation of Reimbursement Settlement For Outpatient

Rehabilitation Services Title XVII. 1810

Part I - Computation of Reimbursement Settlement. 1810.1

Part II - Computation of Lesser of Reasonable Cost or Customary Charges. 1810.2

Worksheet G - Statement of Revenue and Expenses. 1812

Supplemental Worksheet A-8-2 - Provider-Based Physician Adjustments. 1813

Supplemental Worksheet A-8-3 - Reasonable Cost Determination for Physical

Therapy Services Furnished by Outside Suppliers. 1814

Part I - General Information. 1814.1

Part II - Salary Equivalency Computation. 1814.2

Part III - Standard Travel Allowance and Standard Travel Expense Computation

- Provider Site. 1814.3

Part IV - Standard Travel Allowance and Standard Travel Expense - Services. 1814.4

Part V - Overtime Computation. 1814.5

Part VI - Computation of Physical Therapy Limitation and Excess Cost Adjustment. 1814.6

Supplemental Worksheet A-8-4 - Reasonable Cost Determination For Respiratory

Therapy Services Furnished By Outside Suppliers. 1815

Part I - General Information. 1815.1

Part II - Salary Equivalency Computation 1815.2

Part III - Standard Travel Allowance and Standard Travel Expense Computation. 1815.3

Rev. 7 18-1

Chapter 18

Section

Part IV - Overtime Computation. 1815.4

Part V - Computation of Respiratory Therapy

Limitation and Excess Cost Adjustment. 1815.5

Worksheet A-8-5 - Reasonable Cost Determination For Therapy Services

Furnished By Outside Suppliers On Or After April 10, 1998 1816

Part I - General Information 1816.1

Part II - Salary Equivalency Computation 1816.2

Part III - Standard and Optional Travel Allowance and Travel Expense Computation

- Provider Site 1816.3

Part IV - Standard Travel Allowance and Standard Travel Expense - Offsite Services 1816.4

Part V - Overtime Computation 1816.5

art VI - Computation of Therapy Limitation and Excess Cost Adjustment 1816.6

Exhibit 1 - Form CMS-2088-92 Worksheets 1890

E lectronic Reporting Specifications for Form CMS-2088-92 1895

18-2 Rev. 7