CMS-276.Crosswalk for Revisions to Final Cost report & 4th Qtr

Revisions Crosswalk (Form 276-08)

Final & 4^th Quarter Cost Report

Issue #	Page #	Section	Action to be performed	Changes to the Application	Reason for the Change
	Work Sheet E	Line 16	Change to:	Change to: DED+CO on Svcs pd by MAC/Carrier/Intermediary……………....	To reflect CMS’ current terminology for the line referenced
	Work Sheet F, Page 5	Line 16	Change to:	Change to: DED+CO on Svcs pd by the CMS MAC/Carrier/Intermediary............................	To reflect CMS’ current terminology for the line referenced
	Work Sheet G	Line 10	Add:	Add the following lines, 10a Adj. resulting from transactions with related organizations 10b. Adj. resulting from transactions with related organizations 10c. Adj. resulting from transactions with related organizations	To allow plans to separate adjustments for related party transactions
	Work Sheet G	Line 23	Change to:	Change to: Part B coinsurance on services paid by CMS’ MAC/Carriers.........................................	To reflect CMS’ current terminology for the line referenced
	Work Sheet G	Line 24	Change to:	Part B coinsurance on services paid by CMS’ MAC/Intermediaries.........................................	To reflect CMS’ current terminology for the line referenced
	Work Sheet M	Line 5a	Change to:	Part B Deduct on Svcs Pd by CMS' Carriers/Intermediaries/MAC …………………..	To reflect CMS’ current terminology for the line referenced

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