CMS-2552-10_Revisions-Crosswalk

Revisions to Form CMS-2552-10 HOSPITAL COST REPORT REVISION
The overall burden to providers will be unchanged due the provider completing and submitting the hospital cost report with the added legislative
requirements in the Patient Protection and Affordable Care Act (ACA) of 2010 and the Temporary Payroll Tax Cut Continuation Act of 2011.
Changes
Form
CMS –
2552-10
S-2,
Parts I

Issue
#
1

Instructions
Page #
40-33-40-33.1

Form
Page #
40-505-40-506

Section
4003

2

40-46

40-510

4004.2

3

40-59-40-60

40-512

4

40-65

40-513

4005.3

S-3, Part III

5

40-66

40-514

4005.4

S-3, Part IV

S-2, Part II
S-3, Part II

Reason for the Change to the instructions
and accompanying worksheets
Added Lines 61 through 67 (and applicable
lines 25.10 through 25.59) are added to
accommodate and implement sections 5503,
5504, and 5508 of the Patient Protection and
Affordable Care Act (ACA) of 2010.
Added column 2 to line 27 to facilitate the
collection of a geographic reclassification date,
if applicable.
Added lines 118.01 and 118.02 to collect nonpropriety malpractice information and removes
the requirement to answer the malpractice
question on line 119.
Revised line 120 to implement section 308 of
the Temporary Payroll Tax Cut Continuation
Act of 2011 and section 3002 the Middle Class
Tax Relief and Job Creation Act of 2012,
extending outpatient hold harmless payments
for services rendered through February 29,
2012 regardless of bed size for sole community
hospitals (SCHs) (and essential access
community hospitals (EACHs)) and for
services from March 1, 2012 through
December 31, 2012 for all SCHs and EACHs
with 100 or fewer beds.
Added lines 41 through 43 to capture cost
report preparer information.
Subscripted lines 4.01 and 7.01 lines to capture
the costs of Part A teaching physicians and,
contracted interns and residents in an approved
program, respectively.
Revised line 1 instruction to include lines 4.01
and 7.01 in the calculation.
Revised Wage Index Pension cost for line 4

Burden
Effect
N/A

N/A
N/A

N/A
N/A

1

Issue
#
6

Instructions
Page #
40-65-40.65.8

Form
Page #
40-515

Section
4005.5

Form
CMS –
2552-10
S-3, Part V

7

40-73

40-521

4010

S-8

8

40-65

40-523

4012

S-10

9

40-8540-86

40-516

4013

A

10
11

40-107
40-129-40130

N/A
N/A

4017
4023.1

A-8-1, Part A
C, Part I

12

40-137

N/A

4024.5

D, Part V

13

40-139

N/A

4025

D-1

Reason for the Change to the instructions
and accompanying worksheets

Burden
Effect
Added new exhibit to capture wage related that N/A
was formerly on the hospital cost report
questionnaire FORM CMS-339.Clarifies the
instructions for contract labor costs and benefit
costs.
Revised line 15 by adding column 5 to capture N/A
the total visits performed by interns and
residents.
Revised line 1 calculation. Revises lines 8, 12 N/A
and 16 to ensure the proper arithmetic
operation for the calculation for net revenues
and costs. Revised line 27 to reflect total
facility (entire hospital complex) Medicare
reimbursable (also referred to adjusted) bad
debts.
Revised lines 1 and 2 to reflect the elimination N/A
of instructions relating to obligated capital
costs as it no longer necessary to distinguish
between old capital and new capital. Revised
the instructions to column 1 to include all
salary amounts to eliminate the necessity of
applying adjustments.
Added instructions or columns 1 through 6.
N/A
Revised lines 200, 201, and 202 to clarify and N/A
reflect the exclusion of provider based
physician (PBP) clinical laboratory services
for Medicare program beneficiaries (cost
center 61) from total charges to avoid
overstating total charges since the charges on
line 61 are also included on line 60
(laboratory). Line 201 is shaded for columns
1, 3, and 5.
Revised the instructions for column 2 (and
applicable subscripts) to accommodate section
308 of the Temporary Payroll Tax Cut
Continuation Act of 2011 and section 3002 the
Middle Class Tax Relief and Job Creation Act
of 2012.
Minor changes
N/A

2

Issue
#
14

Instructions
Page #
40-169-40176.1

Form
Page #
40-584-40-585

Section
4030.1

Form
CMS –
2552-10
E, Part A

14

40-177

N/A

4030.2

E, Part B

16

40-184

N/A

4031

17

40-184-40185

40-589

4031.2

E-1, Part I,
H-5, Part I,
J-4, Part I, and
M-5
E-1, Part II

18

40-201

N/A

4033.4

E-3, Part IV

19

40-206

N/A

4033.6

E-3, Part VI

20

40-208

N/A

4033.7

E-3, Part VII

Reason for the Change to the instructions
and accompanying worksheets
Revised lines 7, 8, and 9 and added lines 7.01,
8.01, and 8.02 to implement sections 5503 and
5506 of ACA 2010, impacting reductions and
increases, respectively, to the indirect medical
education (IME) cap.
Revised the instructions to subscript column 1
to accommodate section 3138 of ACA
establishing the use of a predetermined
payment to cost ratio (PCR) for cancer
hospitals to calculate the TOPS effective for
services rendered beginning January 1, 2012. .
Revised line 8 instructions to include the
notice of program reimbursement (NPR) date
in column 2.

Burden
Effect
N/A

A note was added for lines 1 through 7
indicating that this data must be transferred to
this worksheet as indicated in the instructions
for reporting periods which cover exactly 12
months. For cost reporting periods which
cover other than exactly 12 months (less than
or greater than 12 months) lines 1 through 7
will have the option to directly input this data.
This results from the requirement that
reporting periods which cover exactly 12
months shall be subject to the standard Health
Information Technology (HIT) formula for
reconciliation and final settlements purposes,
while other than exactly 12 month cost
reporting periods may require a custom HIT
calculation.
Revised line 18 instructions to convey
completion for freestanding long-term care
hospitals (LTCH) only.
Revised line 5 instructions to convey that it is
not to be used since vaccine costs are included
on line 1 of Worksheet E, Part B
Revised lines 5, 8-11, 17, 18, 21, 27, 29, 31
instructions and adds a note prior to line 22 to
clarify the instructions for the calculation of
the Medicaid reimbursement.

N/A

N/A

N/A
N/A
N/A

3

Issue
#
21

Instructions
Page #
40-212-40216.2

22
23

24

Form
Page #
40-598

Section
4034

N/A
N/A
40-285 – 40286

40-661

Form
CMS –
2552-10
E-4

I-5, Part I
L, Part III &
L-1, Part I
4068

M-3

Reason for the Change to the instructions
and accompanying worksheets
Revised lines 2, 3, 5, 27, and 28 and added
lines 3.01, 4.01, and 4.02 to implement select
provisions of ACA 2010, sections 5503 and
5506 impacting reductions and increases to the
direct graduate medical education (GME) cap.
4. Revises line 26 instructions to append title
XIX instructions for inpatient days to facilitate
the computation of patient load.
Clarified the computation of line 10.
Clarified the reference to the additional
payment
exception
for
extraordinary
circumstances is 42 CFR 412.348(f).

Burden
Effect
N/A

N/A
N/A

Added lines 16.01 through 16.05 to implement N/A
section 4104 of ACA which eliminates
coinsurance and deductible for preventive
services furnish by RHCs and FQHCs,
effective for dates of service on or after
January 1, 2011.

4