CMS-2540-10 Crosswalk

Revisions to Form CMS-2540-10 SKILLED NURSING FACILITY AND SKILLED NURSING FACILITY HEALTH CARE
COMPLEX COST REPORT
The revisions to the Form CMS-2540-10:
1. New worksheets for SNF-based hospice worksheets to collect data to facilitate payment reform mandated by §3132 of ACA.
The overall burden to providers is estimated to remain unchanged as the proposed worksheets supersede worksheets currently in the cost report.
Changes
Issue
#
1.

Old Package
Form
CMS-2540-10
S-5

Instructions
Page #
41-34

Form
Page #
41-311

Section
4107

2.

41-37 41-39.2

41-315

4110

S-8, Parts I
and II

3.

41-146 –
41-159

41-403 –
41-415

4164

K; K-1; K-2;
K-3; K-4,
Part I & II;
K-5, Parts I,
II, & III; and
K-6

New Package
Form
CMS-2540-10
S-5

Reason for the Change /
Application of the instructions and
Burden
accompanying worksheets
Effect
Effective for cost reporting periods beginning on
N/A
and after October 1, 2014, SNF-based FQHCs will
no longer complete the Worksheet S-5.
S-8, Parts I, II, Effective for cost reporting periods beginning on
N/A
III and IV
or after October 1, 2015, SNF-based hospices will
no longer complete section I & II instead will
complete Parts III and IV.
O; O-1; O-2;
The forms and instructions are revised in
N/A
O-3; O-4; O-5; accordance with the statutory requirement for
O-6, Parts I & hospice payment reform in §3132 of the Patient
Protection and Affordable Care Act (ACA). These
II; O-7; and
O-8
forms replace the Worksheet K series forms.

1