CMS-276 Manual

Medicare
Provider Reimbursement Manual
Part 2, Provider Cost Reporting Forms and
Instructions, Chapter 11, Form CMS-339
Transmittal 7

Department of Health &
Human Services (DHHS)
Centers for Medicare &
Medicaid Services (CMS)
Date:

HEADER SECTION NUMBERS

PAGES TO INSERT

PAGES TO DELETE

Table of Contents
Sections 1100-1102.3 (cont.)
Exhibits 1 and 2

11-1 (1 p.)
11-3 - 11-8 (6 p.)
11- 9 - 11-14 (6 p.)

11-1 (1 p.)
11-3 – 11-14 (12 p.)
11-15 – 11-39 (25 p.)

REVISED MATERIAL--EFFECTIVE DATE
Sections 1100-1102.3 are being revised to replace the terms “intermediary” and “contractor” with the
term Medicare Administrative Contractor (MAC).
Section 1100 is being revised to identify the providers which still must complete Form CMS-339 -namely, Home Health Agencies (HHAs), Community Mental Health Centers (CMHCs), Rural
Health Clinics and Federally Qualified Health Centers (RHCs/FQHCs), Hospices, and Organ
Procurement Organizations (OPOs).
Section 1102 is streamlined to exclude instructions that do not apply to the type of providers which
are required to complete Form CMS-339.
Section 1102.3 is being revised to delete instructions pertaining to certain sections of Exhibit 1
which were previously completed only by hospitals because hospitals are not currently required to
complete Form CMS-339. (Exhibit 1 and other exhibits in Form CMS-339 which were applicable to
hospitals, SNFs, and ESRD facilities were incorporated into Forms 2552-10, 2540-10, and 265-11,
respectively.)
Additionally, the instructions in Section 1102.3 which pertain to Column 6 of Exhibit 2 (formerly
Exhibit 5) were modified to describe the change in the nature of this column. This column was
changed from “date of write-off” of the bad debt to “”date collection effort ceased”.
The deletion of certain sections of Exhibit 1 which were generally applicable only to hospitals also
resulted in deletion of Exhibits 2 through 4.A and 6 of Form CMS-339. Exhibit 5 which was not
deleted was renumbered as Exhibit 2.
DISCLAIMER: The revision date and transmittal number only apply to material in red
italics. All other material was previously published in the manual and is only being reprinted.

CMS-Pub. 15-2-11