CMS-2540-24 Crosswalk

Form CMS-2540-24 SKILLED NURSING FACILITY AND SKILLED NURSNG FACILITY HEALTHCARE COMPLEX
COST REPORT CROSSWALK
The Form CMS-2540-24, Skilled Nursing Facility and Skilled Nursing Facility Healthcare Complex (SNF) cost report replaces the existing cost
reporting Form CMS-2540-10. The new forms are effective for cost reporting periods beginning on and after October 1, 2022, and ending on or after
September 30, 2023.
Changes in the cost report include:
1. Eliminated Worksheets S-6; S-7; S-8, Parts I and II; D, Parts II and III; and worksheet series I and J for RHC/FQHC and CMHCs.
2. Revised Worksheet S-3. Part I to collect Medicare and Medicaid HMO inpatient days and discharges.
3. Updated Worksheet A to remove obsolete cost centers. Included a column to separately identify contract labor to assist in rate setting
associated with the SNF Patient-Driven Payment Model (PDPM).
4. Added Worksheet A-7, Part II, for capital reconciliation.
5. Added Worksheet C-6 to reclassify charges.
6. Split Worksheet E, Part I, Parts A and B, to two separate worksheets; Worksheet E, Part A, and Worksheet E, Part B.
7. Updated and renamed Worksheet E, Part II, to Worksheet E-2 for titles V and XIX.
8. Eliminated Worksheet G-1 and revised Worksheet G-2 to provide revenue data, broken out by provider payment and delivery system
to support margin analysis by the Office of the Actuary (OACT).
9. Updated the H series of worksheets and Worksheet S-4 to be consistent with the freestanding Form-CMS-1728-20.
10. Redesignated the SNF-based hospice O series of worksheets as K series.
The overall burden to SNFs is estimated at 202 hours which is the same compared to the existing burden associated with the Form CMS-2540-10 of
202 hours taking into consideration both the decreases and increases contained in this revision, and the automation and flow of data amongst
worksheets achieved through minor changes to existing worksheets.

Issue
#

Instructions
Page #

Form
Page #

1. 49-1 - 49-4
2. 49-5 - 49-10
3. 49-11 - 49-13

49-503

4. 49-14 to 49-22 49-504 49-506

Section

4900 4900.40
4901 4901.13
4901.30

Old Package
Form
CMS-2540-10
TOC

New Package
Form
CMS-2540-24
TOC

Reason for the Change/ Application of the Burden
instructions and accompanying worksheets Effect

Table of Contents
Updated general instructions to reflect
revisions in the proposed package.
Worksheet S,
Worksheet S,
Reorganized Worksheet S, Part I and revised
Parts I, II, and III Parts I, II, and III S, Part III, to remove lines for FQHC, RHC,
and CMHC.
Worksheet S-2,
Worksheet S-2
Revised to remove obsolete lines for an
Parts I and II
FQHC, RHC, and CMHC, and removed
obsolete questions.

N/A
N/A
N/A
Decrease

Issue
#

Instructions
Page #

Form
Page #

Section

5. 49-23 - 49-32

49-507 49-511

4901.40 4901.45

6. 49-33 - 49-37

49-512 - 4901.50 49-513
4901.54

Old Package
Form
CMS-2540-10
Worksheet S-3,
Parts I, II, III,
IV, and V

New Package
Form
CMS-2540-24
Worksheet S-3,
Parts I, II, III,
IV, and V

Worksheet S-4

Worksheet S-4,
Parts I, II, III,
and IV

7.

Worksheet S-5

8.

Worksheet S-6

9.

Worksheet S-7,
Parts I and II

10. 49-38 - 49-39

49-514

4901.60 4901.62

Worksheet S-8,
Parts I, II, III,
and IV

Worksheet S-5,
Parts I and II

11. 49-40 - 49-51

49-515 49-518

4902 4902.10

Worksheet A

Worksheet A

12. 49-52 - 49-53

49-519

4902.70

Worksheet A-6

Worksheet A-6

Reason for the Change/ Application of the Burden
instructions and accompanying worksheets Effect
Revised Worksheet S-3. Part I to collect
Medicare and Medicaid HMO inpatient days
and discharges. Revised S-3, Part V, to reflect
previous iteration but added data collection
for Home Office/Chain Organization direct
care expenditures.
Revised form for reporting HHA data
consistent with the freestanding HHA,
Form CMS-1728-20.
Eliminated obsolete worksheet; FQHCs submit
Form CMS-224-14 and RHCs submit
Form CMS-222-17.
Eliminated obsolete worksheet; CMHCs
submit Form CMS-2088-17.

Increase

Eliminated obsolete worksheet as resource
utilization groups (RUG) do not apply to the
new SNF PDPM prospective payment system
(PPS).
Redesignated Form CMS-2540-10,
Worksheet S-8, as Form CMS-2540-23,
Worksheet S-5. Eliminated obsolete portions
of worksheet related to cost reporting periods
beginning before October 1, 2015.
Redesignated Parts III and IV as Parts I and II,
respectively.
Added Contract Labor costs columns.
Removed cost centers for nursing and allied
health education, other long-term care, clinic,
RHC, FQHC, CMHC, malpractice premiums
& paid losses, interest expense and utilization
review. Added additional standard cost
centers. Revised definitions consistent with
language in the statute and regulations.
No change.

Decrease

Increase
Decrease
Decrease

N/A

Increase

N/A

Issue
#

Instructions
Page #

Form
Page #

Section

13. 49-54

49-520

14. 49-55 - 49-57

49-521

4902.80 4902.82
4902.90

15. 49-58 - 49-59

49-522

16. 49-60 - 49-62

49-523

17. 49-63 - 49-66

Worksheet A-8

New Package
Form
CMS-2540-24
Worksheet A-7,
Parts I and II
Worksheet A-8

4902.100
4902.102
4902.110

Worksheet
A-8-1, Parts I
and II
Worksheet A-8-2

Worksheet
A-8-1, Parts I
and II
Worksheet A-8-2

49-524 49-529
&
49-536 49-541
49-530 49-535

4903 4903.10

Worksheets B,
Part I, and B-1

4903.20

19. 49-68
20. 49-69

49-542
49-543

4903.30
4904 4904.10

21. 49-70

49-544

4904.70

22. 49-71

49-545

4905 4905.10

Worksheet D,
Worksheet D
Parts I, II, and III

23. 49-72 - 49-74

49-546

4905.20

Worksheet D-1,
Parts I and II

18. 49-67

Old Package
Form
CMS-2540-10
Worksheet A-7

Reason for the Change/ Application of the Burden
instructions and accompanying worksheets Effect
Added Part II to report reconciliation of capital Increase
costs.
No change.
N/A
Increase

Worksheet B,
Part I, and B-1

Added a column to Worksheet A-8-1, Part II,
to identify the Medicare home office # used
when completing the SNF’s home office cost
statement.
Added a column to report physician
professional hours for informational purposes
only.
Revised worksheets to conform to revisions on
Worksheet A.

Worksheet B,
Part II

Worksheet B,
Part II

Revised worksheet to conform to revisions on
the Worksheet A.

N/A

Worksheet B-2
Worksheet C

Worksheet B-2
Worksheet C

No changes.
Revised worksheet to conform to revisions on
Worksheet A and added a column to transfer
reclassifications of charges from
Worksheet C-6.
Added worksheet to reclassify charges among
cost centers for cost-to-charge ratio
calculations on Worksheet C.
Combined Parts I and II. Eliminated Part III.
Revised worksheet to conform to revisions on
Worksheet A.
Eliminated Part II.

N/A
N/A

Worksheet C-6

Worksheet D-1,
Parts I and II

Increase
N/A

Increase
N/A
N/A

Issue
#

Instructions
Page #

Form
Page #

Section

24. 49-75 - 49-78

49-547 49-548

4906 4906.20

Old Package
Form
CMS-2540-10
Worksheet E,
Part I

25. 49-79 - 49-80

49-549

4906.30

Worksheet E-1

26. 49-81 - 49-84

49-550

4906.40

Worksheet E,
Part II

27. 49-85 49-89
28.

49-551

4908 4908.10

Worksheet G

29. 49-90 - 49-91

49-552

Worksheet G-1

30. 49-92
31. 49-93 49-100

4908.30 - Worksheet G-2,
4908.32
Parts I and II
49-553
4908.40
Worksheet G-3
49-554 - 4909 Worksheet H
49-555
4909.10

32. 49-101 49-106
33. 49-107 49-108

49-556 49-559
49-560 49-565

4909.20
4909.30 4909.32

Worksheet H-1,
Parts I and II
Worksheet H-2,
Parts I and II

34. 49-109 49-111

49-566

4909.40 4909.43

Worksheet H-3,
Parts I and II

35. 49-112 49-114

49-567

4909.50 4909.52

Worksheet H-4,
Parts I and II

New Package
Form
CMS-2540-24
Worksheet E,
Parts A and B

Reason for the Change/ Application of the Burden
instructions and accompanying worksheets Effect

Redesignated Worksheet E, Part I, Part A, as
Worksheet E, Part A; redesignated
Worksheet E, Part I, Part B, as Worksheet E,
Part B; revised worksheet consistent with other
cost reporting settlement worksheets.
Worksheet E-1
Revised worksheet to streamline instructions
and added column 3 to line 8 to report the
notice of program reimbursement (NPR) date.
Worksheet E-2
Redesignated Worksheet E, Part II, as
Worksheet E-2; removed obsolete lines; and
relabeled the deductibles line as cost sharing.
Worksheet G
Revised to eliminate reporting multiple funds
and to remove obsolete lines.
Eliminated Statement of Changes in Fund
Balances collection.
Worksheet G-2, Revised to remove obsolete lines. Expanded
Parts I and II
reporting of patient revenues by payer.
Worksheet G-3
Revised to renumber lines.
Worksheet H
Revised consistent with the
Form CMS-1728-20. Added standard cost
centers to report the cost of administering
vaccines, advertising, and fundraising.
Worksheet H-1, Revised consistent with revisions to
Parts I and II
Worksheet H.
Worksheet H-2, Revised consistent with revisions to
Parts I and II
Worksheet A for SNF overhead costs allocated
to the SNF-based HHA.
Worksheet H-3, Revised consistent with revisions to
Parts I, II, and III Worksheet A for apportionment of SNF-based
HHA costs. Redesignated Part I as Parts I
and II. Redesignated Part II as Part III and
revised consistent with the Form CMS-172820.
Worksheet H-4, Revised consistent with Form CMS-1728-20.
Parts I and II

N/A

N/A
Decrease
N/A
Decrease
Increase
N/A
Increase

N/A
Increase
N/A

N/A

Issue
#

Instructions
Page #

36. 49-115 49-116
37.

Form
Page #

Section

49-568

4909.60

38.

39.

Old Package
Form
CMS-2540-10
Worksheet H-5

New Package
Form
CMS-2540-24
Worksheet H-5

Worksheets I-1,
I-2, I-3, I-4,
and I-5
Worksheets J-1,
Parts I and II;
J-2, Parts I and
2; J-3; and J-4
Worksheet K;
K-1; K-2; K-3;
K-4, Parts I
and II; K-5,
Parts I and II;
and K-6
Worksheet O

Worksheet K

40. 49-117 49-126

49-569 49-570

4912 4912.10

41. 49-127

49-571

4912.20

Worksheet O-1

Worksheet K-1

42. 49-127

49-572

4912.20

Worksheet O-2

Worksheet K-2

43. 49-127

49-573

4912.20

Worksheet O-3

Worksheet K-3

44. 49-127

49-574

4912.20

Worksheet O-4

Worksheet K-4

45. 49-128

49-575

4912.60

Worksheet O-5

Worksheet K-5

46. 49-129 49-131

49-576 49-581

4912.70

Worksheet O-6,
Parts I and II

Worksheet K-6,
Parts I and II

Reason for the Change/ Application of the Burden
instructions and accompanying worksheets Effect
No changes.

N/A

Eliminated obsolete worksheets.

Decrease

Eliminated obsolete worksheets.

Decrease

See also crosswalk items 40 through 48.
Removed old Worksheet K series of
worksheets sunset effective for cost reporting
periods beginning on or after October 1, 2015.

N/A

Redesignated O series of worksheets to new K
series of worksheets and expanded the Direct
Patient Care Services cost centers to include
Drugs Charged to Patients.
Redesignated as Worksheet K-1 and expanded
the Direct Patient Care Services cost centers to
include Drugs Charged to Patients.
Redesignated as Worksheet K-2 and expanded
the Direct Patient Care Services cost centers to
include Drugs Charged to Patients.
Redesignated as Worksheet K-3 and expanded
the Direct Patient Care Services cost centers to
include Drugs Charged to Patients.
Redesignated as Worksheet K-4 and expanded
the Direct Patient Care Services cost centers to
include Drugs Charged to Patients.
Redesignated as Worksheet K-5.

N/A

Redesignated as Worksheet K-6.

N/A

N/A
N/A
N/A
N/A
N/A

Issue
#

Instructions
Page #

Form
Page #

Section
4912.80

Old Package
Form
CMS-2540-10
Worksheet O-7

New Package
Form
CMS-2540-24
Worksheet K-7

47. 49-132

49-582

48. 49-133 49-134

49-583 49-584

4912.90

Worksheet O-8

Worksheet K-8

Reason for the Change/ Application of the Burden
instructions and accompanying worksheets Effect
Redesignated as Worksheet K-7 and revised to
conform to the ancillary cost centers on
Worksheet C.
Redesignated as Worksheet K-8.

Increase
N/A