Crosswalk

FORM CMS-1984-14 HOSPICE COST AND DATA REPORT CROSSWALK
The Form CMS-1984-14, Hospice Cost and Data Report, incorporates changes as noted in the chart below. The overall burden of the
Hospice Cost and Data Report remains unchanged at 188 hours.
FORM CMS-1984-14
WORKSHEETS
INSTRUCTIONS
WORKSHEET
PAGE #
SECTION #
PAGE #
Worksheet S
43-101
4306.1 - 4306.2
43-7 - 43-8
Worksheet S-1
43-102 - 43-103
Worksheet S-2
43-104 - 43-105
Worksheet A
48-106 - 43-107
4310
43-16
Worksheet A-1
Worksheet A-2
Worksheet A-3
Worksheet A-4
Worksheet A-6
Worksheet A-8
Worksheet A-8-1
Worksheet B
and
Worksheet B-1
Worksheet C
Worksheet F
Worksheet F-1
Worksheet F-2

48-108
48-109
43-110
43-111
43-112
43-113
43-114
43-115 - 43-118
and
43-119 - 43-122
43-123
43-124
43-125
43-126

4311
4311
4311
4311
4316
4318
4319
4320

43-26
43-26
43-26
43-26
43-27
43-28 - 43-29
43-30 - 43-31
43-32 - 43-35

4330
4350
4351
4352

43-36 - 43-37
43-38 - 43-41
43-41 - 43-42
43-42 - 43-43

REASON FOR THE CHANGE /
APPLICATION OF THE INSTRUCTIONS
AND ACCOMPANYING WORKSHEETS

No changes.
No changes.
No changes.
Modified the form and instructions to add the
non-reimbursable cost center, line 72, Medicide.
No changes.
No changes.
No changes.
No changes.
No changes.
No changes.
No changes.
Modified the forms and instructions to add the
non-reimbursable cost center, line 72, Medicide.
No changes.
No changes.
No changes.
No changes.

BURDEN
EFFECT
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A