Form CMS-10079 Medicare Wage Index Occupational Mix Survey

MEDICARE WAGE INDEX
OCCUPATIONAL MIX SURVEY

Date:
/
/
Provider Number:
Provider Contact Name:
Provider Contact Phone Number:
Reporting Period: 01/01/2019 – 12/31/2019*

Introduction
Section 304(c) of Public Law 106-554 amended section 1886(d)(3)(E) of the Act
to require CMS to collect data every 3 years on the occupational mix of employees for
each short-term, acute care hospital participating in the Medicare program, in order to
construct an occupational mix adjustment to the wage index. The law also requires the
application of the occupational mix adjustment to the wage index beginning October 1,
2004.
This survey provides for the collection of occupational mix data for a 12month period, that is, * from pay periods ending between January 1, 2019 and
December 31, 2019 to be applied to the FY 2022 wage index. Specifically, the
survey’s begin date cannot be earlier than December 17, 2018, and the survey’s end
date cannot end later than December 31, 2019. Complete the survey for any hospital
that is subject to the inpatient prospective payment system (IPPS), or any hospital
that would be subject to IPPS if not granted a waiver1. [Note: Do not complete this
survey if you are a no/low Medicare utilization provider. Check with your Medicare
Administrative Contractors (MAC) to confirm your status.] It is important for
1

Note: Critical Access Hospitals (CAHs) are not paid under the IPPS, therefore, CAHs are not
required to complete the survey. Also, hospitals that terminated participation in the Medicare
program before January 1, 2019, or terminated after January 1, 2019, but before December 2019,
resulting in less than 11 months of data from CY 2019, are not required to complete the survey.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. T he valid OMB control number for this information collection is xxxxxxxx. T he time required to complete this information collection is estimated to average 480 hours per response,
including the time to review instructions, search existing data resources, gather the data needed, and complete and
review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance
Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. Please do not send applications, claims, payments,
medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note
that any correspondence not pertaining to the information collection burden approved under the associated OMB
control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns
regarding where to submit your documents, please contact T ehila Lipschutz/ Noel Manlove, (410) 786-1344 / (410)

Form CMS-10079 (2019)

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786-5161, [email protected] / [email protected].

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hospitals to ensure that the data reported on the survey are accurate and verifiable
through supporting documentation.
Completed occupational mix surveys must be submitted to MACs (not directly to
CMS), on the Excel hospital reporting form, by July 1, 2020, via email attachment or
overnight delivery.
The Excel version of the occupational mix survey may be obtained from MACs or
downloaded from CMS’s website at:
https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/Wage-Index-Files.html
Instructions and definitions for the data elements and the occupational categories
are attached.

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MEDICARE WAGE INDEX
OCCUPATIONAL MIX SURVEY
Instructions and Definitions

Instructions
Complete this survey for employees who are full-time and part-time, directly hired, and
acquired under contract. Do not include employees in areas excluded from IPPS via
Worksheet S-3, Part II, Lines 9 and 10, such as skilled-nursing facilities, psychiatric, or
rehabilitation units or facilities. This exclusion applies to directly-hired and contract
employees who provide either direct or indirect patient care services in IPPS excluded
areas. Also, do not include employees whose services are excluded from the IPPS, such
as physician Part B, and interns and residents. Include employees who are allocated from
the home office or related organizations to IPPS reimbursable cost centers and outpatient
departments of the hospital that are included in the wage index (i.e., outpatient clinic,
emergency room).
Employees in the home office, related organizations, or general services costs centers
(Worksheet S-3, Part II, Lines 8, 14.01, 14.02 and Lines 26 through 43) typically provide
services throughout the hospital, including the IPPS-excluded areas (Lines 9 and 10). In
completing the survey, a hospital should apply the same methodology it uses for
allocating home office and related organization costs on Worksheet S-3, Part II, and
exclude from the survey such costs associated with excluded areas. If home office or
related organization personnel provide only administrative services, report their wages
and hours in the “All Other Occupations” category. To the extent that there are home
office or related organization personnel that are engaged in nursing activities, they must
be reported in the appropriate nursing subcategory.
Additionally, hospitals should apply the methodology that is used in the wage index
calculation for allocating general service salaries and hours to excluded areas. (See Step
4 of the wage index calculation in 76 FR 51592, August 18, 2011, or in the Wage Index
Calculator at https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/Wage-Index-Files-Items/FY-2019-Wage-Index-HomePage.html. ) Note that, although wage-related costs are included in the general service
allocation methodology for Worksheet S-3, wage-related costs should be excluded from
the general service allocation methodology for the occupational mix survey because the
occupational mix survey excludes wage-related costs.
Nursing personnel working in the following cost centers as used for Medicare cost
reporting purposes must be included in the appropriate nursing subcategory. These cost
centers reflect where the majority of nursing employees are assigned in hospitals and are
selected to ensure consistent reporting among hospitals. The wages and hours for nursing
personnel working in other areas of the hospital that are reimbursable under the IPPS or
OPPS, or nurses who are performing solely administrative functions, would be included
in the “All Other Occupations” category.
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COST CENTER DESCRIPTIONS
Cost Centers
Nursing Administration
Adults and Pediatrics
(General Routine Care)
Intensive Care Unit
Coronary Care Unit
Burn Intensive Care Unit
Surgical Intensive Care
Unit
Other Special Care
(specify)
Nursery
Operating Room
Recovery Room
Labor Room and Delivery
Room
Electrocardiology
Renal Dialysis
Ambulatory Surgical Center
(Non-Distinct Part)
Other Ancillary
Clinics
Emergency
Observation Beds

13
30
31
32
33
34
35
43
50
51
52
69
74
75
76
90
91
92

Note: Subscripted cost centers that would normally fall into one of these cost centers should be included on
the survey.

Definitions
Paid Salaries and Paid Hours:
Paid Salaries – Include the total of paid wages and salaries for the specified
category of hospital employees including overtime, vacation, holiday, sick, lunch,
and other paid-time-off, severance, and bonuses. Do not include fringe benefits
or wage-related costs as defined in Provider Reimbursement Manual, Part II,
Section 4005.2.
Paid Hours – Include the total paid hours for the specified category of hospital
employees. Paid hours include regular hours, overtime hours, paid holiday,
vacation, sick, and other paid-time-off hours, and hours associated with severance
pay. Do not include non-paid lunch periods and on-call hours in the total paid
hours. (Note: On-call hours for the occupational mix survey must be treated the
same as on-call hours for Worksheet S-3 wage data; see Provider Reimbursement
Manual, Part II, section 4005.2, column 5 instructions). Overtime hours must be
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calculated as one hour when an employee is paid time and a half. No hours are
required for bonus pay. The hours reported for salaried employees who are paid a
fixed rate must be recorded based on 40 hours per week or the number of hours in
the hospital’s standard workweek.
Occupational Categories:
[The occupational categories and definitions included in this survey derive directly from the U. S.
Bureau of Labor Statistics (BLS), 2017 Occupational Employment Statistics survey at
https://www.bls.gov/oes/current/oes_stru.htm. The numbers in parentheses are the BLS standard
occupational categories (SOCs). As with the BLS survey, workers should be classified in the
occupation that requires their highest level of skill. If no measurable difference in skills, workers are
to be included in the occupation that they spend the most time.]

Registered Nurses (RNs, SOC 29-1141) - Assess patient health problems and
needs, develop and implement nursing care plans, and maintain medical records.
Administer nursing care to ill, injured, convalescent, or disabled patients. May
advise patients on health maintenance and disease prevention or provide case
management. Licensing or registration required. RNs who have specialized
formal, post-basic education and who function in highly autonomous and
specialized roles, may be assigned a variety of roles such as staff nurse,
advanced practice nurse, case manager, nursing educator, infection control
nurse, performance improvement nurse, and community health nurse. We note
that the 2017 BLS definition for Registered Nurses includes clinical nurse
specialists. However, advanced practice nurses (APNs) (that is, nurse
practitioners, clinical nurse specialists, certified nurse midwives, and certified
registered nurse anesthetists) are usually paid by Medicare under a Part B fee
schedule and not the IPPS. APNs must be excluded from the survey if they are
excluded from Worksheet S-3, Part II but should be included on the survey if they
are included in one of the cost centers for the survey and are included on
Worksheet S-3, Part II.
Licensed Practical and Licensed Vocational Nurses (LPNs, SOC 29-2061)
and Surgical Technologists** (SOC 29-2055) – LPNs: Care for ill, injured, or
convalescing patients or persons with disabilities in hospitals, nursing homes,
clinics, private homes, group homes, and similar institutions. May work under
the supervision of a registered nurse. Licensing required. Surgical
Technologists: Assist in operations, under the supervision of surgeons,
registered nurses, or other surgical personnel. May help set up operating room,
prepare and transport patients for surgery, adjust lights and equipment, pass
instruments and other supplies to surgeons and surgeon's assistants, hold
retractors, cut sutures, and help count sponges, needles, supplies, and
instruments.
Nursing Assistants (SOC 31-1014) and Orderlies (31-1015) - Nursing
Assistants: Provide basic patient care under direction of nursing staff. Perform
duties such as feed, bathe, dress, groom, or move patients, or change linens. May
transfer or transport patients. Includes nursing care attendants, nursing aides, and
nursing attendants. Orderlies: Transport patients to areas such as operating
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rooms or x-ray rooms using wheelchairs, stretchers, or moveable beds. May
maintain stocks of supplies or clean and transport equipment.

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Medical Assistants** (SOC 31-9092) - Performs administrative and certain
clinical duties under the direction of physician. Administrative duties may
include scheduling appointments, maintaining medical records, billing, and
coding information for insurance purposes. Clinical duties may include taking
and recording vital signs and medical histories, preparing patients for
examination, drawing blood, and administering medications as directed by
physician. Exclude “Physician Assistants” (29-1071).
Include only those employees who perform administrative and certain clinical
functions under the direction of a physician in the IPPS cost centers and
outpatient areas of the hospital that are listed above. Do not include
phlebotomists, information technology personnel, health information
management personnel, medical secretaries, ward clerks, and general business
office personnel.
**Note: Medical Assistants and Surgical Technologists are “nursing” employees for
purposes of the occupational mix survey. Whenever the terms “nursing staff”, “nursing
personnel”, “nursing occupations”, “nursing employees”, or “nursing categories” are used
with regards to the occupational mix survey, they are deemed to include medical assistants
and surgical technologists.
Note: Only nurses, surgical technologists, nursing aides/orderlies/attendants, and medical
assistants, as defined on the survey, can be included in the respective RNs, LPNs, Surgical
Technologists, Aides/Orderlies/Attendants, and MAs categories. Do not include other
occupations that may provide similar services as nursing personnel. Instead, those
occupations (if assigned to IPPS/OPPS areas of the hospital) must be included in the All
Other Occupations category. For example, hospital-based paramedics may provide services
that are similar to those provided by nursing personnel; however, on the occupational mix
survey, these non-nursing occupations must be included in All Other Occupations. This is to
ensure consistent reporting among hospitals.

All Other Occupations – Non-nursing employees (directly hired and under
contract) in IPPS reimbursable cost centers and outpatient departments that are
included in the wage index (i.e., outpatient clinic, emergency room) must be
included in the “All Other Occupations” category. In addition, this category
would include the wages and hours of nurses (including APNs) that function
solely in administrative or leadership roles, that do not directly supervise staff
nurses who provide patient care, and do not provide any direct patient care
themselves. This category must not include occupations that are excluded from
the wage index (such as physician Part B services, interns, residents, and the
services of APNs - nurse practitioners, clinical nurse specialists, certified nurse
midwives, and certified registered nurse anesthetists – that are excluded from the
wage index because their services are billable under a Part B fee schedule).
Also, the “All Other Occupations” category must not include employees in areas
of the hospital that are excluded from the wage index via Worksheet S-3, Part II,
Lines 8 and 8.01, such as skilled nursing, psychiatric, and rehabilitation units and
facilities. Therapists and therapy assistants, equipment technologists and
technicians, medical and clinical laboratory staff, pharmacists and pharmacy
technicians, administrators (other than nursing), computer specialists, dietary, and
housekeeping staff are examples of employees who should be reported in the “All
Other Occupations” category. Also include the wages and hours of personnel
from the home office or related organizations if they perform solely
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administrative functions and work in IPPS cost centers and outpatient departments
that are included in the wage index.
Note: Do not include salaries and hours for APNs (nurse practitioners, clinical nurse
specialists, nurse midwives, or certified registered nurse anesthetists) in any of the Nursing
or All Other Occupations categories if their services are billable under Medicare Part B.
The services of these nurses are generally billable under a Part B fee schedule and excluded
from the wage index because they are not paid under the hospital inpatient prospective
payment system (IPPS).

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MEDICARE WAGE INDEX
OCCUPATIONAL MIX SURVEY
Date:
/
/
Provider Number:
Provider Contact Name:
Provider Contact Phone Number:
Reporting Period: Pay Periods Ending Between 01/01/2019 and 12/31/2019

Report Paid Salaries and Paid Hours in whole numbers. Round Average Hourly Wage to 2 decimal
places.

Occupational Category
Nursing Occupations
RNs
LPNs, LVNs, and Surgical Technologists
Nursing Assistants and Orderlies
Medical Assistants
Total Nursing

Paid
Salaries

Paid
Hours

Average
Hourly
Wage
(Salaries/Hours)

All Other Occupations
Total (Nursing and All Other)
Note:

Do not mark in shaded areas.

Form CMS-10079 (2019)

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