Instruction, Section 4195 - Crosswalk

CROSSWALK SECTION 4195

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2540-10

1. Text regarding “S-3, Part V” added to Table 2 - Worksheet Indicators

Worksheets That Apply to the SNF Cost Report

	Worksheet	Worksheet Indicator -
	S-3, Part V	S300005

2. Text regarding “WORKSHEET S-3, PART V” added to Table 3 - List of Data Elements with Worksheet, Line, and Column Designations

WORKSHEET S-3, PART V

	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE
Registered Nurses (RN)	1	1-3	9	9
Licenses Practical Nurses (LPN)	2	1-3	9	9
Nursing Assistants/Aids	3	1-3	9	9
Physical Therapists	4	1-3	9	9
Physical Therapy Assistants	5	1-3	9	9
Physical Therapy Aids	6	1-3	9	9
Occupational Therapists	7	1-3	9	9
Occupational Therapy Assistants	8	1-3	9	9
Occupational Therapy Aids	9	1-3	9	9
Speech Therapists	10	1-3	9	9
Respiratory Therapists	11	1-3	9	9
Other Medical Staff	12	1-3	9	9
Registered Nurses (RN)	13	1	9	9
Licenses Practical Nurses (LPN)	14	1	9	9
Nursing Assistants/Aids	15	1	9	9
Physical Therapists	16	1	9	9
Physical Therapy Assistants	17	1	9	9
Physical Therapy Aids	18	1	9	9
Occupational Therapists	19	1	9	9
Occupational Therapy Assistants	20	1	9	9
Occupational Therapy Aids	21	1	9	9
Speech Therapists	22	1	9	9
Respiratory Therapists	23	1	9	9
Other Medical Staff	24	1	9	9

3. Text regarding Worksheet S-3 revised to include Part “V” in Table 3C ‑ Lines That Cannot be Subscripted (Beyond Those Preprinted)

	Worksheet	Lines
	S-3, Parts II III IV&V	All