Part 444 - Description Of Accounts

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2803, 2803-b, 3612

Section 444.1 - Preface

Section 444.1 Preface. (3000) This Part provides a detailed description for each Balance Sheet and Income Statement account listed in the Listing of Accounts, Part 443 of this Article. A standard unit of measure and the data source for each standard unit of measure is provided for each cost center where a standard unit of measure is required. In addition, a detailed explanation is provided for the natural expense classification.
 

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BALANCE SHEETS

Section 444.2 - Unrestricted Fund assets

BALANCE SHEETS

444.2 UNRESTRICTED FUND ASSETS. (3110)

(a) CURRENT ASSETS. (3111)

(1) 1010 CASH

1011 General Checking Accounts

1012 Payroll Checking Accounts

1013 Other Checking Accounts

1014 Imprest Cash Funds

1015 Savings Account

1016 Certificates of Deposit

1019 Other Cash Accounts

These cash accounts represent the amount of cash on deposit in banks and immediately available for use in financing Unrestricted Fund activities, amounts on hand for minor disbursements, and amounts invested in savings accounts and certificates of deposit.

(2) 1020 INVESTMENTS

1021 U.S. Government Securities

1022 Other Current Investments

1023 Share of Pooled Investments

1029 Other Investments

Current securities and investments, evidenced by certificates of ownership or indebtedness, must be reflected in these accounts.

(3) 1030 ACCOUNTS AND NOTES RECEIVABLES

1031 Inpatient Receivables--Inhouse

1032 Inpatient Receivables--Discharged and Unbilled

1033 Inpatient Receivables--Medicare

1034 Inpatient Receivables--Medicaid

1035 Inpatient Receivables--Other

1036 Outpatient Receivables--Unbilled

1037 Outpatient Receivables--Medicare

1038 Outpatient Receivables--Medicaid

1039 Outpatient Receivables--Other

(i) These accounts shall reflect the amounts due from hospital patients and their third-party sponsors.

(ii) Separate accounts may be maintained for different levels of inpatient care (i.e., Acute and Intensive, Skilled Nursing, etc.) and outpatient care (i.e., Emergency Room, Clinic) and for different payors, if desired. This may be accomplished by the inclusion of digits to the right of the decimal point.

(iii) Notes receivable and accounts receivable may also be segregated, but there is usually little to be gained from this practice, as the amount of notes receivable will usually be nominal.

(iv) 1031 Inpatient Receivables--Inhouse

This account shall reflect all charges and credits (at the hospital's full established rates) for medical services rendered to patients still in hospital.

(v) 1032 Inpatient Receivables--Discharged and Unbilled

This account shall reflect all charges and credits (at the hospital's full established rates) for medical services rendered to patients who have been discharged but not yet billed.

(vi) 1033 Inpatient Receivables--Medicare--Discharged and Billed

This account should be used only if the hospital is not on the Periodic Interim Payment Program. The balance in this account reflects all unpaid charges billed to the Medicare intermediary. Direct billings to the Medicare inpatient (or to Medicaid) for deductibles, coinsurance, and other patient-chargeable items would also be included in this account if such billings were not included in Inpatient Receivables--Other (or Inpatient Receivables--Medicaid).

(vii) 1034 Inpatient Receivables--Medicaid--Discharged and Billed

The balance in this account reflects all unpaid charges billed to Medicaid. Direct billings to the Medicaid inpatient (or to the Medicare intermediary) for deductibles, coinsurance, other patient-chargeable items and items under "Part B" Medicare coverage would also be included in this account if such billings were not included in Inpatient Receivables--Other (or Inpatient Receivables--Medicare).

(viii) 1035 Inpatient Receivables--Other--Discharged and Billed

Include in this account all unpaid billings for medical services and supplies provided to all non-Medicare, non-Medicaid inpatients. Direct billings to Medicare and Medicaid inpatients for deductibles, coinsurance, and other patient-chargeable items may also be included if they are not included elsewhere.

(ix) 1036 Outpatient Receivables--Unbilled

This account reflects all unbilled charges and credits (at the hospital's full established rates) for medical services rendered to outpatients.

(x) 1037 Outpatient Receivables--Medicare

The balance in this account reflects all unpaid charges billed to the Medicare intermediary. Direct billings to the Medicare outpatient (or to Medicaid) for deductibles, coinsurance, and other patient-chargeable items would also be included in this account if such billings were not included in Outpatient Receivables--Other (or Outpatient Receivables--Medicaid).

(xi) 1038 Outpatient Receivables--Medicaid

The balance in this account reflects all unpaid charges billed to Medicaid. Direct billings to the Medicaid outpatient (or to the Medicare intermediary) for deductibles, coinsurance, other patient-chargeable items, and "Part B" coverage, would also be included in this account if such billings are not included in Outpatient Receivables--Other (or Outpatient Receivables--Medicare). (xii) 1039 Outpatient Receivables--Other

Include in this account all unpaid billings for medical services and supplies provided to all non-Medicare, non-Medicaid outpatients. Direct billings to Medicare and Medicaid outpatients for deductibles, coinsurance, and other patient-chargeable items may also be included if they are not included elsewhere.

(4) 1040 ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES AND THIRD-PARTY CONTRACTUALS

1041 Allowance for Bad Debts

1042 Allowance for Contractual Adjustments--Medicare

1043 Allowance for Contractual Adjustments--Medicaid

1047 Allowance for Contractual Adjustments--Other

1049 Allowance for Other Adjustments

These are valuation (or contra-asset) accounts whose credit balances represent the estimated amount of uncollectible receivables from patients and third-party payors. For details on the computation of the related deductions from revenue, see the account descriptions of the Deductions from Revenue accounts.

(5) 1050 RECEIVABLES FROM THIRD-PARTY PAYORS

(i) 1051 PIP Clearing Account

During the year, this account reflects the difference between amounts billed to the Medicare intermediary for applicable services rendered, and periodic interim payments received from the Medicare intermediary. At year-end, this account must be closed out, with the balance going to the account entitled Contractual Adjustment--Medicare.

1052 Other Receivables--Third-Party Cost Report

Settlement--Medicare

1053 Other Receivables--Third-Party Cost Report

Settlement--Medicaid

1059 Other Receivables--Third-Party Cost Report

Settlement--Other

(ii) The balance of this account reflects the amount due from third-party reimbursement programs based upon cost reports submitted and/or audited. Subaccounts may be maintained for each year's settlement if more than one year's settlement is included in an account.

(6) 1060 PLEDGES AND OTHER RECEIVABLES

1061 Pledges Receivable

1062 Allowance for Uncollectible Pledges

1063 Grants and Legacies Receivable

1064 Interest Receivable

1065 Accounts and Notes Receivable--Staff, Employees, etc.

1066 Intercompany Advances, Current

1069 Other Receivables

These accounts reflect other amounts due to the Operating Fund for other than patient services.

(7) 1070 DUE FROM OTHER FUNDS

1072 Due from Board-Designated Assets

1073 Due from Plant Replacement and Expansion Fund

1074 Due from Specific Purpose Fund

1075 Due from Endowment Fund

The balances in these accounts reflect the amounts due from designated assets or restricted funds to the Operating Fund. The balance of these accounts should not be construed as a receivable in the sense that a claim external to the hospital exists. Instead, this balance should be viewed as representing assets of the Operating Fund which are currently accounted for as restricted funds.

(8) 1080 INVENTORY

1081 Inventory--General Stores

1082 Inventory--Pharmacy

1083 Inventory--Central Services and Supplies

1084 Inventory--Dietary

1085 Inventory--Plant Operating and Maintenance

1089 Inventory--Other

These balances reflect the cost of unused hospital supplies. Any generally accepted cost method (e.g., FIFO, LIFO, etc.) may be used as long as it is consistent with that of the preceding accounting period. The extent of inventory control and detailed recordkeeping will depend upon the size and organizational complexity of the hospital.

(9) 1090 PREPAID EXPENSES AND OTHER CURRENT ASSETS

1091 Prepaid Insurance

1092 Prepaid Interest

1093 Prepaid Rent

1094 Prepaid Pension Plan Expense

1095 Prepaid Taxes

1096 Prepaid Service Contracts

1097 Other Prepaid Expenses

1098 Deposits

1099 Other Current Assets

These prepaid asset and other current asset accounts represent costs incurred which are properly chargeable to a future accounting period. Other current assets not included elsewhere are also contained in these accounts.

(b) BOARD DESIGNATED ASSETS. (3112)

(1) 1110 CASH

1111 General Checking Accounts

1113 Other Checking Accounts

1115 Savings Accounts

1116 Certificates of Deposit

1119 Other Cash Accounts

(2) 1120 INVESTMENTS

1121 U.S. Government Securities

1122 Other Current Investments

1123 Share of Pooled Investments

1129 Other Investments

(3) 1160 PLEDGES AND OTHER RECEIVABLES

1161 Pledges Receivable

1162 Allowance for Uncollectible Pledges

1163 Grants and Legacies Receivable

1169 Other Receivables

(4) 1170 DUE FROM OTHER FUNDS

1173 Due from Plant Replacement and Expansion Fund

1174 Due from Specific Purpose Fund 1175 Due from Endowment Fund

(5) 1190 PREPAID EXPENSES AND OTHER CURRENT ASSETS

1199 Other Current Assets

(6) Included in these accounts are assets which have been designated (or appropriated) by the governing board for special use.

(c) PROPERTY, PLANT AND EQUIPMENT. (3113)

(1) 1200 LAND

The balance of this account reflects the cost of land used in hospital operations. Included here is the cost of offsite sewer and water lines, public utility charges for servicing the land, governmental assessments for street paving and sewers, the cost of permanent roadways and of grading of a nondepreciable nature, the cost of curbs and of sidewalks whose replacement is not the responsibility of the hospital, as well as other land expenditures of a nondepreciable nature. Unlike buildings and equipment, land does not deteriorate with use or with the passage of time; therefore, no depreciation is accumulated.

(2) 1210 LAND IMPROVEMENTS

1211 Parking Lots

1219 Other Land Improvements

All land expenditures of a depreciable nature that are used in hospital operations are charged to this account. This would include the cost of onsite sewer and water lines; paving of roadways, parking lots, curbs and sidewalks (if replacement is the responsibility of the hospital), as well as the cost of shrubbery, fences and walls.

(3) 1220 BUILDINGS

1221 Hospital

1224 Clinic

1225 Student Housing Facility

1226 Employee Housing Faculty

1227 Non-Paid Workers Housing Facility

1228 Skilled Nursing Facility

1229 Parking Structure

The cost of all buildings and subsequent additions used in hospital operations shall be charged to this account. Included are all architectural, consulting and legal fees related to the acquisition or construction of buildings. Interest paid during construction financing is a cost of the building and is included in this account.

(4) 1230 FIXED EQUIPMENT

1231 Hospital

1234 Clinic

1235 Student Housing Facility

1236 Employee Housing Facility

1237 Non-Paid Workers Housing Facility

1238 Skilled Nursing Facility

1239 Parking Structure

(i) The cost of all fixed equipment used in hospital operations shall be charged to this account. Fixed equipment has the following general characteristics:

Affixed to the building, not subject to transfer or removal.

A life of two or more years, but less than that of the building to which it is affixed.

Used in hospital operations.

(ii) Fixed equipment includes such items as boilers, generators, elevators, engines, pumps and refrigeration machinery, including the plumbing, wiring, etc. necessary for equipment operations.

(5) 1240 LEASEHOLD IMPROVEMENTS

All expenditures for the improvement of a leasehold used in hospital operations shall be charged to this account.

(6) 1250 EQUIPMENT

(i) 1251 Major Movable Equipment

Equipment to be charged to this account has the following general characteristics:

Ability to be moved, as distinguished from fixed equipment.

A more or less fixed location in the building.

A unit cost large enough to justify the expense incident to control by means of an equipment ledger.

Sufficient individuality and size to make control feasible by means of identification tags.

A minimum useful life at time of acquisition of three years or more.

Used in hospital operations.

Major movable equipment includes such items as automobiles and trucks, desks, beds, chairs, accounting machines, sterilizers, operating tables, oxygen tents and X-ray apparatus.

(ii) 1259 Minor Movable Equipment

Equipment to be charged to this account has the following general characteristics:

Location generally not fixed; subject to requisition or use by various cost centers of the hospital.

Relatively small in size and unit cost.

Subject to storeroom control.

Fairly large number in use.

A useful life of less than three years.

Used in hospital operations.

Minor equipment includes such items as wastebaskets, bedpans, basins, glassware, silverware, pots and pans, sheets, blankets, ladders, and surgical instruments.

(7) 1260 CONSTRUCTION-IN-PROGRESS

1261 Buildings

1262 Fixed Equipment

1263 Major Movable Equipment

1264 Fees

1265 Insurance

1266 Interest

Cost of construction that will be in progress for more than one month and will be used for hospital operations should be charged to these accounts. Upon completion of the construction program, these accounts should be credited and the appropriate asset account(s) debited.

(8) 1270 ACCUMULATED DEPRECIATION--LAND IMPROVEMENTS

1271 Parking Lots 1279 Other Land Improvement s

(9) 1280 ACCUMULATED DEPRECIATION--BUILDINGS

1281 Hospital

1284 Clinic

1285 Student Housing Facility

1286 Employee Housing Facility

1287 Non-Paid Workers Housing Facility

1288 Skilled Nursing Facility

1289 Parking Structure

(10) 1290 ACCUMULATED DEPRECIATION--FIXED EQUIPMENT

1291 Hospital

1294 Clinic

1295 Student Housing Facility

1296 Employee Housing Facility

1297 Non-Paid Workers Housing Facility

1298 Skilled Nursing Facility

1299 Parking Structure

(11) 1310 ACCUMULATED DEPRECIATION--LEASEHOLD IMPROVEMENTS

(12) 1320 ACCUMULATED DEPRECIATION--EQUIPMENT

1321 Major Movable Equipment

1329 Minor Movable Equipment

(13) The balances in accounts 1270 through 1329 reflect the depreciation accumulated on the above-mentioned assets used in hospital operations.

(d) OTHER TANGIBLE ASSETS. (3114)

(1) 1330 INVESTMENT IN NON-OPERATING PROPERTY,

PLANT AND EQUIPMENT

(2) 1340 ACCUMULATED DEPRECIATION--INVESTMENTS IN

NONOPERATING PROPERTY, PLANT AND EQUIPMENT

(3) 1350 OTHER TANGIBLE ASSETS

1351 Intercompany Advances, Non-Current

(4) Accounts 1330 and 1340 include the cost (or fair market value at date of donation) of property, plant and equipment not used in hospital operations and accumulated depreciation thereon. Other tangible assets not included elsewhere are contained in account 1350.

(e) INTANGIBLE ASSETS. (3115)

(1) 1360 GOODWILL

(2) 1370 UNAMORTIZED BORROWING COSTS

(3) 1380 PREOPENING AND OTHER ORGANIZATIONAL COSTS

1381 Preopening Costs

1389 Other Organization Costs

(4) 1390 OTHER INTANGIBLE ASSETS

(5) Accounts 1360-1390 are used to record intangible assets. If such intangibles are being amortized, the amortization may be directly credited to the asset account, or accumulated in a subaccount. Account 1360, Goodwill, contains the excess of the price paid for a business as a whole over the book value, or over the computer or agreed value of all tangible net assets purchased. Account 1370, Unamortized Borrowing Costs, includes such items as legal fees, underwriting fees, etc.
 

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Section 444.3 - Restricted Fund assets

444.3 RESTRICTED FUND ASSETS. (3120)

(a) PLANT REPLACEMENT AND EXPANSION FUND ASSETS. (3121)

(1) 1510 CASH

1511 General Checking Accounts

1513 Other Checking Accounts

1515 Savings Accounts

1516 Certificates of Deposit

1519 Other Cash Accounts

Cash donated for the replacement and expansion of plant assets is included in these accounts.

(2) 1520 INVESTMENTS

1521 U.S. Government Securities

1522 Other Current Investments

1523 Share of Pooled Investments

1529 Other Investments

The balance of these accounts reflects the cost of investments purchased with Plant Replacement and Expansion Fund cash and the fair market value (at the date of donation) of securities donated to the hospital for the purpose of plant renewal or replacement.

(3) 1550 OTHER TANGIBLE ASSETS

(4) 1560 PLEDGES AND OTHER RECEIVABLES

1561 Pledges Receivable

1562 Allowance for Uncollectible Pledges

1563 Grants and Legacies Receivable

1564 Interest Receivable

1569 Other Receivables

Other tangible assets and the receivable and allowance balances of this fund are reflected in these accounts.

(5) 1570 DUE FROM OTHER FUNDS

1571 Due from Operating Fund

1572 Due from Board-Designated Assets

1574 Due from Specific Purpose Fund

1575 Due from Endowment Fund

The balance in these accounts represents the amount due to the Plant Replacement and Expansion Fund from the other funds. These accounts represent assets of the Plant Replacement and Expansion Fund which are currently accounted for in other funds.

(b) SPECIFIC PURPOSE FUND ASSETS. (3122)

(1) 1710 CASH

1711 General Checking Accounts

1713 Other Checking Accounts

1715 Savings Accounts

1716 Certificates of Deposit

1719 Other Cash Accounts

Cash donated for specific purposes, such as research and education, is included in these accounts.

(2) 1720 INVESTMENTS

1721 U.S. Government Securities

1722 Other Current Investments

1723 Share of Pooled Investments

1729 Other Investments

The balance of these accounts reflects the cost of investments purchased with Specific Purpose Fund cash and the fair market value (at the date of donation) of securities donated to the hospital for specific purposes.

(3) 1750 OTHER TANGIBLE ASSETS

(4) 1760 PLEDGES AND OTHER RECEIVABLES

1761 Pledges Receivable

1762 Allowance for Uncollectible Pledges

1763 Grants and Legacies Receivable

1764 Interest Receivable

1769 Other Receivables

Other tangible assets and the receivable and allowance balances of this fund are reflected in these accounts.

(5) 1770 DUE FROM OTHER FUNDS

1771 Due from Operating Fund

1772 Due from Board-Designated Assets

1773 Due from Plant Replacement and Expansion Fund

1775 Due from Endowment Fund

The balance in these accounts represents the amount due to the Specific Purpose Fund from the other funds. These accounts represent assets of the Specific Purpose Fund which currently are accounted for in other funds.

(c) ENDOWMENT FUND ASSETS. (3123)

(1) 1810 CASH

1811 General Checking Accounts

1813 Other Checking Accounts

1815 Savings Accounts

1816 Certificates of Deposit

1819 Other Cash Accounts

Cash restricted for endowment purposes is included in these accounts.

(2) 1820 INVESTMENTS

1821 U.S. Government Securities

1822 Other Current Investments

1823 Share of Pooled Investments

1824 Real Property

1825 Accumulated Depreciation on Real Property

1826 Mortgages

1829 Other Investments

The balance of these accounts reflects the cost of investments purchased with Endowment Fund cash and the fair market value (at the date of donation) of non-cash donations to the hospital for Endowment Fund purposes. Included would be such assets as Real Property and related accumulated Depreciation and Mortgages.

(3) 1830 INVESTMENT IN NON-OPERATING PROPERTY,

PLANT AND EQUIPMENT

(4) 1840 ACCUMULATED DEPRECIATION--INVESTMENTS IN

NONOPERATING PROPERTY, PLANT AND EQUIPMENT

(5) 1850 OTHER TANGIBLE ASSETS

(6) Accounts 1830 and 1840 include the cost (or fair market value at date of donation) of restricted property, plant and equipment not used in hospital operations and accumulated depreciation thereon. Other tangible assets not included elsewhere are contained in account 1850.

(7) 1860 PLEDGES AND OTHER RECEIVABLES

1861 Pledges Receivable

1862 Allowance for Uncollectible Pledges

1863 Grants and Legacies Receivable

1864 Interest Receivable

1869 Other Receivables

Other tangible assets and the receivable and allowance balances of this fund are reflected in these accounts. Included in account 1869 would be rent, dividends and trust income receivable. (8) 1870 DUE FROM OTHER FUNDS

1871 Due from Operating Fund

1872 Due from Board-Designated Assets

1873 Due from Plant Replacement and Expansion Fund

1874 Due from Specific Purpose Fund

The balance in these accounts represents the amount due to the Endowment Fund from the other funds. These accounts represent assets of the Endowment Fund which currently are accounted for in other funds.
 

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Section 444.4 - Unrestricted fund liabilities

444.4 UNRESTRICTED FUND LIABILITIES. (3130)

(a) CURRENT LIABILITIES. (3131)

(1) 2010 NOTES AND LOANS PAYABLE

2011 Notes and Loans Payable--Vendors

2012 Notes and Loans Payable--Banks

2013 Current Portion of Long-Term Debt

2019 Other Notes and Loans Payable

These accounts reflect liabilities of the hospital to vendors, banks and others, evidenced by promissory notes due and payable within one year.

(2) 2020 ACCOUNTS PAYABLE

2021 Trade Payables

2029 Other Accounts Payable

The balance of these accounts must reflect the amounts due trade creditors and others for supplies and services purchased.

(3) 2030 ACCRUED COMPENSATION AND RELATED LIABILITIES

2031 Accrued Payroll

2032 Accrued Vacation, Holiday and Sick Pay

2033 Other Accrued Salaries and Wages Payable

2034 Non-Paid Workers Services Payable

2035 Federal Income Taxes Withheld

2036 Social Security Taxes Withheld and Accrued

2037 State Income Taxes Withheld

2038 Local Income Taxes Withheld

2039 Unemployment Taxes Payable

2041 Accrued Hospitalization Insurance Premiums

2042 Union Dues Payable

2049 Other Payroll Taxes and Deductions Payable

The balances of these accounts reflect the actual or estimated liabilities of the hospital for salaries and wages payable, as well as related amounts payable for payroll taxes withheld from salaries and wages, payroll taxes to be paid by the hospital, and other payroll deductions, such as hospitalization insurance premiums. Non-Paid Worker Services Payable (account 2034) refers to amounts payable to Motherhouses, etc. for the services of nonpaid workers.

(4) 2050 OTHER ACCRUED EXPENSES

2051 Interest Payable

2052 Rent Payable

2053 Property Taxes Payable

2054 Fees Payable--Medical Specialists

2055 Fees Payable--Other

2059 Other Accrued Expenses Payable

These accounts include the amounts of those current liabilities that have accumulated at the end of the month or accounting period because of expenses, incurred up to that time.

(5) 2060 ADVANCES FROM THIRD-PARTY PAYORS

2061 Advances--Medicare

2062 Advances--Medicaid

2063 Advances--Blue Cross

2069 Advances--Other

Include in these accounts liabilities to third-party payors for current financing and other types of advances due and payable within one year.

Do not include liabilities to third-party payors arising from reimbursement settlements. Such liabilities must be included in account 2070--Payable to Third-Party Payors.

(6) 2070 PAYABLE TO THIRD-PARTY PAYORS

2071 Reimbursement Settlement Due--Medicare

2072 Reimbursement Settlement Due--Medicaid

2073 Reimbursement Settlement Due--Blue Cross

2079 Reimbursement Settlement Due--Other

These accounts reflect reimbursement settlements due to third-party payors. Separate sub-accounts may be maintained within each account for each year's settlement included.

(7) 2080 DUE TO OTHER FUNDS

2082 Due to Board-Designated Assets

2083 Due to Plant Replacement and Expansion Fund

2084 Due to Specific Purpose Fund

2085 Due to Endowment Fund

These accounts reflect the amounts due to other funds by the Operating Fund. Under no circumstances should these accounts be construed as payables in the sense that an obligation external to the hospital exists.

(8) 2090 INCOME TAXES PAYABLE

2091 Federal Income Taxes Payable

2092 State Income Taxes Payable

2093 Local Income Taxes Payable

Include in these accounts the amount of current income taxes payable.

(9) 2110 OTHER CURRENT LIABILITIES

2111 Deferred Income--Patient Deposits

2112 Deferred Income--Tuition and Fees

2113 Deferred Income--Other

Deferred income is defined as income received or accrued which is applicable to services to be rendered within the next accounting period and/or the current year's effect of deferred income items classified as non-current liabilities.

Deferred income applicable to accounting periods extending beyond the next accounting period should be included in accounts 2120-2140 (Deferred Credits and Other Liabilities) or in account 2270 (Other Non-Current Liabilities).

2114 Dividends Payable

2115 Current Maturities of Long-Term Debt

2116 Intercompany Indebtedness, Current

2117 Construction Retention Payable

2118 Construction Contracts Payable

2119 Other Current Liabilities

Include in these accounts the amount of Operating Fund current liabilities for which special accounts have not been provided elsewhere, including bank overdrafts.

(b) DEFERRED CREDITS AND OTHER LIABILITIES. (3132)

(1) 2120 DEFERRED INCOME TAXES

2121 Deferred Taxes Payable--Federal 2122 Deferred Taxes Payable--State

2123 Deferred Taxes Payable--Local

(2) 2130 DEFERRED THIRD-PARTY REVENUE

2131 Deferred Revenue--Medicare

2132 Deferred Revenue--Medicaid

2133 Deferred Revenue--Blue Cross

2139 Deferred Revenue--Other

These accounts reflect the effects of any timing differences between book and tax or third-party reimbursement accounting.

(3) 2140 OTHER DEFERRED CREDITS

This account should reflect all deferred credits not specifically identified elsewhere.

(c) LONG-TERM DEBT. (3133)

2210 Mortgages Payable--FHA

2220 Mortgages Payable--Other

2230 Construction Loans

2240 Notes Under Revolving Credit

2250 Capitalized Lease Obligations

2260 Bonds Payable--Taxable

2270 Bonds Payable--Tax Exempt

2280 Intercompany Indebtedness, Non-current

2280 Other Non-current Liabilities

These accounts reflect those liabilities that have maturity dates extending more than one year beyond the current year-end.

(d) BOARD-DESIGNATED LIABILITIES. (3134)

(1) 2480 DUE TO OTHER FUNDS

2483 Due to Plant Replacement and Expansion Fund

2484 Due to Specific Purpose Fund

2485 Due to Endowment Fund

These accounts reflect the amounts due to other funds by Board-Designated Assets.
 

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Section 444.5 - Restricted fund liabilities

444.5 RESTRICTED FUND LIABILITIES. (3140)

(a) PLANT REPLACEMENT AND EXPANSION FUND LIABILITIES. (3141)

2580 DUE TO OTHER FUNDS

2581 Due to Operating Fund

2582 Due to Board-Designated Assets

2584 Due to Specific Purpose Fund

2585 Due to Endowment Fund

These accounts reflect the amounts due to other funds by the Plant Replacement and Expansion Fund.

(b) SPECIFIC PURPOSE FUND LIABILITIES. (3142)

2780 DUE TO OTHER FUNDS

2781 Due to Operating Fund

2782 Due to Board-Designated Assets

2783 Due to Plant Replacement and Expansion Fund

2785 Due to Endowment Fund

These accounts reflect the amounts due to other funds by the Specific Purpose Fund.

(c) ENDOWMENT FUND LIABILITIES. (3143)

(1) 2810 MORTGAGES PAYABLE

(2) 2870 OTHER NON-CURRENT LIABILITIES

(3) These accounts reflect liabilities on Endowment Fund assets that existed at the time the assets were received by the hospital or were incurred subsequent to receipt of these assets, based upon the endowment agreement.

(4) 2880 DUE TO OTHER FUNDS

2881 Due to Operating Fund

2882 Due to Board-Designated Assets

2883 Due to Plant Replacement and Expansion Fund

2884 Due to Specific Fund

These accounts reflect the amounts due to other funds by the Endowment Fund.
 

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Section 444.6 - Fund balances

444.6 FUND BALANCES. (3150)

(a) NON-PROFIT (3151)

(1) UNRESTRICTED FUND BALANCE

(i) 2290 FUND BALANCE

2292 Depreciation Funds

2294 Transfers from Restricted Funds for Capital Outlay

2296 Value of Donated Property, Plant and Equipment

(ii) Unrestricted Fund balances represent the difference between the total of Unrestricted Fund Assets and Unrestricted Fund Liabilities, i.e., the net assets of the Unrestricted Fund.

(iii) Separate sub-accounts may be maintained for the above when applicable.

(iv) The Transfers from Restricted Funds for Capital Outlay account should be credited for the cost of capital items purchased directly by the Unrestricted Fund with funds from the Plant Replacement and Expansion Fund. The fair market value of donated property, plant and equipment (at the date of donation) should be credited to the Donated Property, Plant and Equipment account. At the end of the year these accounts should be closed out to the Fund Balance account.

(v) Depreciation Funds (account 2292) represents amounts restricted by third-party payors for replacement of specified assets.

(2) PLANT REPLACEMENT AND EXPANSION FUND BALANCE

(i) 2690 FUND BALANCE

2691 Restricted Project Funds

2692 Depreciation Funds

2693 Donor-Restricted Funds

2695 Transfers to Unrestricted Fund for Capital Outlay

2696 Value of Donated Property, Plant and Equipment

2697 Transfers to Operating Fund for Operating Purposes

(ii) The credit balances of these accounts represent the net amount of this restricted fund's assets available for its designated purpose. These accounts must be credited for all income earned on restricted fund assets, as well as gains and losses on the disposal of such assets. If, however, such items are to be treated as Unrestricted Fund income (considering legal requirements and donor intent), the Restricted Fund Balance account should be charged, and the Due to Unrestricted Fund account credited, for such income.

(iii) Depreciation Funds (account 2692) represents amounts restricted by third-party payors for replacement of specified assets.

(iv) Accounts 2695 and 2697 are debit balance accounts and during the year the balance of the accounts would reflect the amounts transferred to the Unrestricted Fund for capital outlay and operating purposes. At the end of the year the balances of these sub-accounts should be closed out to the Fund Balance account.

(v) Account 2696 reflects the fair market value, at the date of donation, of donor-restricted property, plant and equipment.

(3) SPECIFIC PURPOSE FUND BALANCE

(i) 2790 FUND BALANCE

2791 Restricted Project Funds

2793 Donor-Restricted Funds

2795 Transfers to Unrestricted Fund for Capital Outlay

2796 Value of Donated Property, Plant and Equipment

2797 Transfers to Operating Fund for Operating Purposes

(ii) The credit balances of these accounts represent the net amount of this restricted fund's assets available for its designated purpose. These accounts must be credited for all income earned on restricted fund assets, as well as gains on the disposal of such assets. If, however, such items are to be treated as Unrestricted Fund income (considering legal requirements and donor intent), the Restricted Fund Balance account should be charged, and the Due to Operating Fund account credited, for such income.

(iii) Accounts 2795 and 2797 are debit balance accounts and during the year the balance of the accounts would reflect the amounts transferred to the Unrestricted Fund for capital outlay and operating purposes. At the end of the year the balances of these sub-accounts should be closed out to the Fund Balance account.

(iv) Account 2796 reflects the fair market value at the time of donation of donor-restricted property, plant and equipment.

(4) ENDOWMENT FUND BALANCE

(i) 2890 FUND BALANCE

2893 Donor-Restricted Funds

2895 Transfers to Unrestricted Funds for Capital Outlay

2896 Value of Donated Property, Plant and Equipment

2897 Transfers to Operating Fund for Operating Purposes

(ii) The credit balances of these accounts represent the net amount of this restricted fund's assets available for its designated purpose. These accounts must be credited for all income earned on restricted fund assets, as well as gains on the disposal of such assets. If, however, such items are to be treated as Operating Fund income (considering legal requirements and donor intent), the Restricted Fund Balance account should be charged, and the Due to Operating Fund account credited, for such income.

(iii) Accounts 2895 and 2897 are debit balance accounts and during the year the balance of the accounts would reflect the amounts transferred to the Unrestricted Fund for capital outlay and operating purposes. At the end of the year the balance of these sub-accounts should be closed out to the Fund Balance account. (iv) Account 2896 reflects the fair market value at the time of donation of donor-restricted property, plant and equipment.

(b) INVESTOR-OWNED CORPORATION. (3152)

2350 STOCKHOLDER'S EQUITY

2351 Preferred Stock

2352 Common Stock

2353 Treasury Stock

2360 Additional Paid-in Capital

2370 Retained Earnings

The total of these equity accounts reflects the difference between the total assets and the total liabilities of the Investor-Owned Corporation.

(c) INVESTOR-OWNED PARTNERSHIP OR SOLE PROPRIETOR. (3153)

2380 CAPITAL--PARTNERSHIP OR SOLE PROPRIETOR

2381 Capital

2382 Partner's Draw

The total of these accounts represents the net assets of the Partnership or Sole Proprietor.
 

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INCOME STATEMENTS

Section 444.7 - General

INCOME STATEMENTS

444.7 General. (3200) An Income Statement is an accounting statement which reflects the financial results of a hospital during a reporting period.

(b) Hospitals are required to report all revenue and expense accounts in this section when such a function as defined in this manual exists, even though the activity is not separately organized within the hospital. The only circumstances under which the hospital need not report a revenue or expense account is when the patient services provided in a daily hospital services cost center is not provided in a discrete unit. For example, if pediatric patients receive care in the Medical/Surgical acute cost center no reclassification of expense from the Medical/Surgical cost center to the Pediatric Acute cost center is required. No functional reporting of revenue and expense is required for daily hospital service cost centers.

(c) Where a function required by the reporting system is not separately organized within the hospital, but combined with one or more functions required by the reporting system, an analysis will be required to determine the gross revenue and direct expenses applicable to each required function. For instance, some hospitals may be combining the function of Electrocardiography (accounts 4290/7290 and Neurology-Diagnostic (accounts 4460/7460). In such cases, it is necessary to determine the total direct revenue and direct expenses relative to the two different types of services rendered, and if significant, as defined below, reclassification is required.

(d) The gross revenue reported in each required revenue account must be the actual gross revenue attributable to such identified functions. The expenses reported in each required expense account must represent the direct expenses related to each identified function. The direct expenses related to such functions may be determined based upon analysis.

(e) It should be noted that reclassification must be made for significant amounts of misplaced costs or revenue. Significant is defined, for the purposes of this Article, as an amount equivalent to an aggregate amount of misplaced costs or revenue in excess of the lesser of:

(1) three percent of the direct costs of the functional center transferred to or from; or

(2) one quarter of one percent of the total annual operating expenses.

(f) However, in no case is a reclassification necessary if the aggregate amount of misplaced cost per cost center is less than $1,000.

(g) Since the zero level accounts presented in this manual are required, all zero level accounts presented herein, except as noted above, must be reported by the hospital where the related item or function exists in that hospital. A hospital will not be granted an exception to the reporting of an account solely because of accounting difficulty.
 

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Section 444.8 - Operating revenue accounts--general

444.8 Operating revenue accounts--general. (3210) (a) Hospital revenue consists mainly of the value, at the hospital's full established rates, of all hospital services rendered to patients, regardless of amounts actually paid to the hospital by or on behalf of patients. The objective of patient service revenue reporting is to compile complete and accurate information, on the accrual basis, of gross revenue, by revenue centers and by inpatient and outpatient classification, and a record of revenue deductions, classified by type.

(b) Patient service revenues must be reported in such a manner as to clearly identify these revenues with the functional ambulatory and ancillary services cost centers and the discrete daily hospital services cost centers of the hospital. Revenues of revenue producing cost centers are needed for comparison with the expenses of the center, so that operating performances can be evaluated.

(c) In addition to patient service revenue, hospitals obtain revenue from sources and activities only indirectly related to patient care. These "other" operating revenues typically consist of tuition revenue, parking lot revenue, nonpatient food sales, etc.

(d) Regardless of the source of hospital revenue, it is important that it be reported for on the accrual basis. This basis of reporting requires that revenue be recognized and reported in the time period it is earned, irrespective of the timing of the cash flow between the hospital and other parties. No other basis provides the necessary qualities of completeness, accuracy, and usefulness of financial data and/or the proper basis for matching revenues with expenses. The requirement for accrual reporting is only that the reports be prepared on the accrual basis and not that the books be maintained on that basis throughout the reporting period. Hospitals will be permitted two reporting periods in which to meet the accrual reporting requirements. The Health Care Financial Administration (HCFA) will consider requests for waivers where a State law requires other than full accrual accounting.

(e) The operating revenue accounts in the Listing of Accounts are classified into five categories.
 

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Section 444.9 - Operating revenue--daily hospital services

444.9 Operating revenue--daily hospital services. (3211) This group of accounts (3000-3990) is used to report the gross revenue, measured in terms of the hospital's full established rates, earned from daily hospital services rendered to inpatients. These revenues must be reported at the hospital's full established rates, regardless of the amounts actually collected.

(b) Daily hospital services generally are those services included by the provider in a daily service charge--sometimes referred to as the "room and board" charge. Included in daily hospital services are the regular room, dietary and nursing services, minor medical and surgical supplies, medical social services, and the use of certain equipment and facilities for which the hospital does not customarily make a separate charge.

(c) Daily hospital services are categorized into broad areas: acute care, intensive care, nursery, and sub-acute care.

(d) Acute Care. This group of accounts (3010-3290) is used to report the gross revenues, measured in terms of the hospital's full established rates earned from daily hospital services provided to patients who are in an acute phase of illness but not to the degree which requires the concentrated and continuous observation and care provided in the intensive care units of a hospital.

(e) Intensive Care. (1) This group of accounts (3310--3490) is used to report the gross revenues measured in terms of the hospital's full established rates earned from inpatients who require extraordinary observation and care on a concentrated basis.

(2) The intensive care unit must meet the following conditions:

(i) The unit must be physically and identifiably separate from other areas. There cannot be a concurrent sharing of nursing staff between an intensive care type unit and units or areas furnishing different levels or types of care. However, two or more intensive care type units that concurrently share nursing staff can be reported as one combined intensive care type unit if all other criteria are met. Float nurses (nurses who work in different units on an as-needed basis) can be utilized in the intensive care type unit.

(ii) There must be specific written policies that include criteria for admission to, and discharge from, the unit.

(iii) Registered nursing care must be furnished on a continuous 24-hour basis. At least one registered nurse must be present in the unit at all times.

(iv) A minimum nurse/patient ratio of one nurse to two patients per patient day must be maintained. Included in the calculation of this nurse/patient ratio are registered nurses, licensed vocational nurses, licensed practical nurses, and nursing assistants who provide patient care. Not included are general support personnel such as ward clerks, custodians and housekeeping personnel.

(v) The unit must be equipped with, or have available for immediate use, lifesaving equipment necessary to treat the critically ill patients for which it is designed. This equipment may include, but is not limited to, respiratory and cardiac monitoring equipment, respirators, cardiac defibrillators, and wall or canister oxygen and compressed air.

(f) Nursery. These accounts (3510 & 3520) are used to report gross revenues measured in terms of the hospital's full established rates earned from nursery services provided to newborn infants who require routine and/or premature care.

(g) Sub-Acute Care. This group of accounts (3610-3690) is used to report the gross revenues measured in terms of the hospital's full established rates earned from services provided to patients who require a level of nursing care less than acute, including residential care.
 

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Section 444.10 - Operating revenue--ambulatory services

444.10 Operating revenue--ambulatory services. (3212) This group of accounts (3710- 3990) is used to report the gross revenue, measured in terms of the hospital's full established rates, earned from ambulatory services. The essential characteristic distinguishing ambulatory services is that patients arrive at a facility of the hospital for a purpose other than admission as an inpatient. For reporting purposes, ambulatory services also include ambulance, free-standing clinic, and home health services.
 

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Section 444.11 - Operating revenue--ancillary services

444.11 Operating revenue--ancillary services. (3213) The group of accounts

(4010- 4990) is used to report the gross revenues, measured in terms of the hospital's full established rates, earned from ancillary services. Ancillary services generally are those special services for which charges are customarily made in addition to daily hospital services charges, and include such services as laboratory, diagnostic radiology, surgery services, etc. Ancillary services are usually billed as separate items when the patient receives these services.
 

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Section 444.12 - Operating revenue--other operating revenue

444.12 Operating revenue--other operating revenue. (3214) This group of accounts (5010-5890) is used to report all operating revenues other than those that are directly associated with patient care.
 

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Section 444.13 - Operating revenue--deductions from revenue

444.13 Operating revenue--deductions from revenue. (3215) This group of accounts (5900--5990) is used to report reductions in gross revenue arising from bad debts, contractual adjustments, uncompensated care, administrative, courtesy, policy discounts, and adjustments and other revenue deductions.
 

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Section 444.14 - Patient revenue account descriptions

444.14 Patient revenue account descriptions. (3221) (a) The specific patient revenue accounts and related expense accounts are listed in Part 443 of this Article. Detailed descriptions of the functions or types of activities to be included in each revenue center are included in the cost center descriptions which follow. The revenue relative to these functions and activities must be reported in the revenue account matching the cost center in which the costs are reported. For example, charges for Pediatric Acute services are reported in Pediatric Acute (account 3170) and the cost of the services are reported in Pediatric Acute (account 6170). Emergency Services are reported in Emergency Services (account 3710) and the cost of the services are reported in Emergency Services (account 6710). Thus a matching of revenues and expenses is achieved within each cost center.

(b) For the new reporting requirements contained in the following subdivisions of this section, the initial reporting year is indicated in parentheses. For example, account 3620--Skilled Nursing Care--Medicaid Certified in subdivision (f) of this section has 1980 in parentheses. This means this revenue center must be reported for the reporting period beginning in 1980 and thereafter. All other revenue centers are required to be reported for reporting periods beginning in 1979 and thereafter.

(c) DAILY HOSPITAL SERVICES--ACUTE CARE REVENUE.

3010 MEDICAL/SURGICAL ACUTE

3170 PEDIATRIC ACUTE

3210 PSYCHIATRIC ACUTE

3250 OBSTETRICS ACUTE

3280 DEFINITIVE OBSERVATION

3290 OTHER ACUTE CARE

(d) DAILY HOSPITAL SERVICES--INTENSIVE CARE REVENUE.

3310 MEDICAL/SURGICAL INTENSIVE CARE

3330 CORONARY CARE

3331 Myocardial Infarction

3332 Pulmonary Care

3333 Heart Transplant

3339 Other Coronary Care

3350 PEDIATRIC INTENSIVE CARE

3370 NEO-NATAL INTENSIVE CARE

3380 BURN CARE

3390 PSYCHIATRIC INTENSIVE CARE

3410 OTHER INTENSIVE CARE I

3420 OTHER INTENSIVE CARE II (1980 Optional)

3430 OTHER INTENSIVE CARE III (1980 Optional)

(e) DAILY HOSPITAL SERVICES--NURSERY REVENUE

3510 NEWBORN NURSERY

3520 PREMATURE NURSERY

(f) DAILY HOSPITAL SERVICES--SUB-ACUTE CARE REVENUE.

3610 SKILLED NURSING CARE--MEDICARE OR MEDICARE/MEDICAID CERTIFIED (1980)

3620 SKILLED NURSING CARE--MEDICAID CERTIFIED (1980)

3630 PSYCHIATRIC LONG-TERM CARE

3640 TUBERCULOSIS LONG-TERM CARE (1980)

3650 INTERMEDIATE CARE--MENTALLY RETARDED (1982)

3660 INTERMEDIATE CARE--OTHER (1980)

3670 RESIDENTIAL CARE

3680 OTHER SUB-ACUTE CARE SERVICES

3680 OTHER SUB-ACUTE CARE HOSPITAL SERVICES (1982)

3690 OTHER SUB-ACUTE CARE NON-HOSPITAL SERVICES (1982)

(g) AMBULATORY SERVICES REVENUE

3710 EMERGENCY SERVICES

3711 Emergency Room

3712 Observation

3719 Other Emergency Services

3720 CLINIC SERVICES

3721 Allergy Clinic

3722 Cancer Clinic

3723 Cardiology Clinic

3724 Dental Clinic

3725 Dermatology Clinic

3726 Diabetic Clinic

3727 Drug Abuse Clinic

3728 Ear, Nose and Throat Clinic

3729 Eye Clinic

3731 General Medicine Clinic

3732 Obstetrics/Gynecology Clinic

3733 Orthopedic Clinic

3734 Pediatric Clinic

3735 Physical Medicine Clinic

3736 Psychiatric Clinic

3737 Surgery Clinic

3738 Urology Clinic

3739 Venereal Disease Clinic

3799 Other Clinic Services

3810 HOME PROGRAM DIALYSIS--EQUIPMENT--100% (1980)

3820 HOME PROGRAM DIALYSIS--OTHER (1980)

3830 AMBULATORY SURGERY SERVICES

3840 PSYCHIATRIC DAY AND NIGHT CARE SERVICES

3850 AMBULANCE SERVICES

3860 OTHER AMBULATORY SERVICES

3870 FREE STANDING CLINIC I

3880 FREE STANDING CLINIC II (1980 Optional)

3890 FREE STANDING CLINIC III (1980 Optional)

3910 HOME HEALTH SERVICES--SKILLED NURSING CARE (1980)

3920 HOME HEALTH SERVICES--MEDICAL SOCIAL SERVICES (1980)

3930 HOME HEALTH SERVICES--HOME HEALTH AIDES (1980)

3990 HOME HEALTH SERVICES--OTHER HOME HEALTH (1980)

(h) ANCILLARY SERVICES REVENUE

4010 LABOR AND DELIVERY SERVICES

4040 SURGERY SERVICES (1980)

4041 General Surgery

4042 Open Heart Surgery

4043 Neurosurgery

4044 Orthopedic Surgery

4045 Kidney Transplant

4046 Other Organ Transplants

4049 Other Surgical Services

4060 RECOVERY SERVICES (1980)

4080 ANESTHESIOLOGY

4110 MEDICAL SUPPLIES SOLD

4130 DURABLE MEDICAL EQUIPMENT--SOLD (1982)

4140 DURABLE MEDICAL EQUIPMENT--LEASED/RENTED (1982)

4150 DRUGS SOLD

4210 LABORATORY SERVICES--CLINICAL

4211 Chemistry

4212 Hematology

4213 Immunology(Serology)

4214 Microbiology(Bacteriology)

4215 Procurement and Dispatch

4216 Urine and Feces

4219 Other Clinical Laboratories

4230 LABORATORY SERVICES--PATHOLOGICAL

4231 Cytology

4232 Histology

4233 Autopsy

4239 Other Pathological Laboratories

4250 WHOLE BLOOD AND PACKED RED CELLS (1980)

4260 BLOOD STORING AND PROCESSING 4290 ELECTROCARDIOGRAPHY

4310 CARDIAC CATHETERIZATION LABORATORY

4320 RADIOLOGY--DIAGNOSTIC

4321 Angiocardiography

4322 Ultrasonography

4339 Radiology--Diagnostic--Other

4340 CT SCANNER

4360 RADIOLOGY--THERAPEUTIC

4380 NUCLEAR MEDICINE

4381 Nuclear Medicine--Diagnostic

4382 Nuclear Medicine--Therapeutic

4420 RESPIRATORY THERAPY

4440 PULMONARY FUNCTION TESTING

4460 NEUROLOGY--DIAGNOSTIC

4461 Electroencephalography

4462 Electromyography

4510 PHYSICAL THERAPY

4530 OCCUPATIONAL THERAPY

4550 SPEECH-LANGUAGE PATHOLOGY

4570 RECREATIONAL THERAPY

4580 AUDIOLOGY

4590 OTHER PHYSICAL MEDICINE

4670 PSYCHIATRIC/PSYCHOLOGICAL SERVICES

4671 Individual Therapy

4672 Group Therapy

4673 Family Therapy

4674 Biofeedback

4675 Psychological Testing

4676 Electric Shock Therapy

4689 Other Psychiatric/Psychological Services

4710 RENAL DIALYSIS

4711 Hemodialysis

4713 Peritoneal Dialysis

4715 Patient Dialysis Training

4719 Other Dialysis

4730 KIDNEY ACQUISITION

4750 OTHER ORGAN ACQUISITION

4910 OTHER ANCILLARY SERVICES
 

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Section 444.15 - Other operating revenue account descriptions

444.15 Other operating revenue account descriptions. (3222)

(a) 5020 TRANSFERS FROM RESTRICTED FUNDS FOR RESEARCH EXPENSES

This account reflects the amount of transfers from restricted funds to the Operating Fund to match expenses incurred in the current period by the Operating Fund for restricted fund research activities.

(b) 5220 NURSING EDUCATION

5221 Registered Nurses

5222 Licensed Vocational (Practical) Nurses

5240 POSTGRADUATE MEDICAL EDUCATION--APPROVED TEACHING PROGRAMS

5250 POSTGRADUATE MEDICAL EDUCATION--NON-APPROVED TEACHING PROGRAMS

5260 OTHER HEALTH PROFESSION EDUCATION

5261 School of Medical Technology

5262 School of X-ray Technology

5263 School of Respiratory Therapy

5264 Administrative Intern Program

5265 Medical Records Librarian Program

These accounts (5220-5260) are used to report the revenue from the schools of nursing, postgraduate medical education, paramedical education, and other educational activities.

(c) 5280 TRANSFERS FROM RESTRICTED FUNDS FOR EDUCATION EXPENSES

This account reflects the amounts of transfers from restricted funds to the Operating Fund to match expenses incurred in the current period by the Operating Fund for restricted fund educational activities.

(d) 5320 NON-PATIENT FOOD SALES

This account is used to report the revenue earned in the hospital cafeteria for meals served to employees and others. Also included is revenue from employees and others for meals when the hospital does not operate a formal cafeteria.

(e) 5330 LAUNDRY AND LINEN SERVICES REVENUE

This account shall be used to report revenue earned by providing laundry services to other organizations (both related and nonrelated) and to employees and students housed on hospital property.

(f) 5350 SOCIAL WORK SERVICES REVENUE

This account shall be used to report revenue earned by providing social work services to patients and others.

(g) 5360 HOUSING REVENUE

5361 Employee Housing

5363 Student Housing

This account is used to report revenue from room (or cot) rentals provided for employees and students.

(h) 5440 PARKING REVENUE

Amounts received from visitors, employees and others in payment for parking privileges shall be reported in this account.

(i) 5450 HOUSEKEEPING SERVICES REVENUE

This account shall be used to report revenue earned by providing housekeeping services to other organizations (both related and nonrelated).

(j) 5610 TELEPHONE AND TELEGRAPH REVENUE

Amounts received from patients, employees and others in payment of hospital telephone and telegraph services shall be reported in this account.

(k) 5620 DATA PROCESSING SERVICES REVENUE

This account shall be used to report revenue earned by providing data processing services to other organizations (both related and nonrelated).

(l) 5690 PURCHASING SERVICES REVENUE

This account shall be used to report revenue earned by providing purchasing services to other organizations (both related and nonrelated).

(m) 5710 SALE OF ABSTRACTS/MEDICAL RECORDS

This account shall be used to report revenue earned for medical records transcript and abstract fees.

(n) 5760 DONATED COMMODITIES

Donated medicines, linen, office supplies and other materials which would normally be purchased by a hospital shall be reported at fair market value in this account. An offsetting amount is reported in an appropriate inventory account or cost center.

(o) 5770 DONATED BLOOD

Donated blood is reported at fair market value in this account. An offsetting amount is reported in the blood inventory account or Whole Blood and Packed Red Cells cost center (account 7250).

(p) 5780 CASH DISCOUNTS ON PURCHASES

The amounts of cash discounts taken by the hospital on purchases shall be reported in this account. Trade discounts, however, shall be treated as reductions in the cost of items purchased.

(q) 5790 SALE OF SCRAP AND WASTE

This account shall be used to report the revenue from the sale of scrap and waste.

(r) 5810 REBATES AND REFUNDS

This account shall be used to report the revenue from rebates and refunds of expense.

(s) 5820 VENDING MACHINE COMMISSIONS

Commissions earned by the hospital from coin-operated telephones and vending machines shall be reported in this account.

(t) 5830 OTHER COMMISSIONS

Commissions earned by the hospital, other than commissions from coin-operated telephones and vending machines shall be reported in this account.

(u) 5840 TELEVISION/RADIO RENTALS

This account shall be used to report the revenue from television and radio rentals, when the activity is hospital-conducted.

(v) 5850 NON-PATIENT ROOM RENTALS

This account is used to report revenue from room (or cot) rentals charged to non-patients.

(w) 5860 MANAGEMENT SERVICES REVENUE

This account shall be used to report revenue earned by providing management services to other organizations (both related and nonrelated).

(x) 5870 OTHER OPERATING REVENUE This account shall be used to report other operating revenue not included elsewhere.

(y) 5880 TRANSFERS FROM RESTRICTED FUNDS FOR OTHER OPERATING EXPENSES

This account reflects the amounts of transfers from restricted funds to the Operating Fund to match expenses incurred in the current period by the Operating Fund for restricted fund activities other than the transfers from restricted funds reported in account 5020 (Transfers from Restricted Funds for Research Expenses) and account 5280 (Transfers from Restricted Funds for Education Expenses).
 

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Section 444.16 - Deductions from revenue account descriptions

444.16 Deductions from revenue account descriptions. (3223) (a) In many instances, the hospital receives less than its full established charges for the services it renders. It is essential that reporting information reflect both the gross revenue and revenue adjustments resulting from inability to collect established charges for services provided. These revenue adjustments are called Deductions from Revenue and are of the following primary categories:

(1) Provisions for bad debts. These deductions represent the estimated amount of current revenue that will not be realized as a result of credit losses.

(2) Contractual adjustments. These adjustments represent the difference between full established charges for individual services and the contractual rates received or to be received from third-party payors for services rendered.

(3) Charity service. These deductions represent the difference between full established charges and amounts received or to be received from indigent patients, voluntary agencies or governmental units on behalf of specific indigent patients.

(4) These deductions are reported under two accounts. One account is used to report those charges pertaining to compliance with the Hill-Burton Hospital and Medical Facilities Construction Plan, and another one for all other uncompensated charity care charges.

(5) Policy discounts. These deductions represent adjustments for items such as courtesy allowances and employee discounts from the hospital's full established charges for services.

(6) Administrative adjustments. These adjustments represent amounts of patient service revenue posted but not billed to patients because the cost of billing and collection would exceed the amounts received.

(b) The above items must be reported as deductions from gross operating revenue on an accrual basis rather than as expenses.

(c) 5900 PROVISION FOR BAD DEBTS

This account shall contain the hospital's periodic estimates of the amounts of accounts and notes receivable that are likely to be credit losses. The estimated amount of bad debts may be based on an experience percentage applied to the balance of accounts receivable or the amount of charges to patients' accounts during the period, or it may be based on a detailed aging and analysis of patients' accounts.

(d) 5910 CONTRACTUAL ADJUSTMENTS--MEDICARE

5911 Medicare - Part A

5912 Medicare - Part B

5920 CONTRACTUAL ADJUSTMENTS--MEDICAID

5930 CONTRACTUAL ADJUSTMENTS--BLUE CROSS

5940 CONTRACTUAL ADJUSTMENTS--OTHER

(1) These accounts must be used to report the differential (if any) between the amount, based on the hospital's full established rates, of contractual patients' charges for hospital services which are rendered during the reporting period and are covered by the contract, and the amount received and to be received from third-party agencies in payment of such charges, including adjustments made at year-end, based upon Cost Reports submitted.

(2) Prior period contractual revenue adjustments, as appropriate, will also be reported in these accounts rather than in the Fund Balance or Retained Earnings accounts.

(3) Should the hospital receive more than its established rates from an agency, the differential is reported in these accounts.

(e) 5950 CHARITY/UNCOMPENSATED CARE--HILL-BURTON

5960 CHARITY/UNCOMPENSATED CARE--OTHER

(1) These accounts are used to report the differential between the amount, based on the hospital's full established rates, of charity/uncompensated care patients' bills for hospital services and the amount (if any) to be received from such patients in payment for such services.

(2) Account 5950 shall be used to report the charges applicable to any charity/uncompensated care which is being used to comply with requirements of the Hill-Burton Hospital and Medical Facilities Construction Plan.

(3) When the hospital receives lump-sum grants or subsidies (rather than specific payments for individual patients' bills) from governmental or voluntary agencies for the care of medically indigent patients, the amount of the lump-sum grant or subsidy must be reported under "Restricted Donations and Grants for Indigent Care" (account 5970).

(f) 5970 RESTRICTED DONATIONS AND GRANTS FOR INDIGENT CARE

This account is used to report voluntary and governmental agency grants or subsidies for the care of nonspecified medically indigent patients during the current reporting period.

(g) 5980 ADMINISTRATIVE, COURTESY AND POLICY DISCOUNTS AND ADJUSTMENTS

This account shall be used to report write-offs of debit or credit balances in patients' accounts in which the cost of billing or refunding exceeds the amount of the account balance. In addition, reductions in the nature of courtesy allowances and employee discounts, from the hospital's established rates for services rendered, must be reported in this account. (h) 5990 OTHER DEDUCTIONS FROM REVENUE

Other deductions from revenue which are not included elsewhere must be reported in this account.
 

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Section 444.17 - Operating expenses--general

444.17 Operating expenses--general. (3230) (a) Expenses are expired costs, that is, costs that have been used up in carrying on some activity during the accounting period and from which no future measurable benefit will be obtained. Hospital expenses consist primarily of employee compensation, but substantial amounts of expense are in the form of supplies used, utilities, repairs, insurance, depreciation and other items. The objective of expense accounting is to accumulate, on the accrual basis, complete and meaningful records of expenses. Within each cost center, the expenses are classified, according to natural classification by the use of the fifth and sixth digits in the numerical coding system.

(b) Hospitals are required to use in the required reports all revenue and expense accounts which have capitalized titles and which have numerical codes with a fourth digit of zero (except where noted) when such a function as defined in this manual exists, even though the activity is not separately organized within the hospital. The only circumstances under which the hospital need not report an existing zero level account are when the patient service provided in a Daily Hospital Services cost center is not provided in a discrete unit.

(c) PATIENT SERVICE EXPENSE. This group of accounts (6000-7999) is used to report the direct expenses incurred in providing nursing and other professional services (daily hospital services, ambulatory services and ancillary services) rendered to patients. For each nursing and other professional service revenue center account a corresponding cost center account is provided. The second, third and fourth digits of the account numbers of the related revenue and expense cost centers are the same. Comparisons of the revenue and direct expense of each nursing and other professional service center are thereby facilitated.

(d) OTHER OPERATING EXPENSE. This group of accounts (8000-8999) is used to report the direct expenses incurred by the research, education, general, fiscal and administrative cost centers, and various unassigned cost centers. When cost finding procedures are performed, the expenses charged to these centers are allocated to the various patient service expense cost centers to determine the full cost of providing each revenue producing service.

(e) The following pages contain detailed descriptions of the functions or types of activities to be included in each cost center, the name and definition of the applicable standard unit of measure and the data source of the standard unit of measure.

(f) STANDARD UNITS OF MEASURE. The Standard Unit of Measure is required to provide a uniform statistic for measuring costs. The Standard Unit of Measure for revenue producing cost centers (Daily Hospital, Ambulatory, and Ancillary Services) attempts to measure the volume of services rendered to patients (productive output). For non-revenue producing cost centers, the Standard Unit of Measure attempts to measure the volume of support services rendered. The Standard Unit of Measure provides a method of determining unit cost and revenue to facilitate cost and revenue comparisons among peer group health facilities.

Standard Units of Measure should not be confused with allocation statistics used to allocate cost of non-revenue producing cost centers to each other and to the revenue producing centers.
 

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Section 444.18 - Daily hospital services expenses description

444.18 Daily hospital services expenses description. (3250)

(a) Acute care. (3251)

(1) 6010 MEDICAL/SURGICAL ACUTE

(i) Function. Medical/Surgical Acute Care Units provide care to patients on the basis of physicians' orders and approved nursing care plans. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing of dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Medical/Surgical acute patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(2) 6170 PEDIATRIC ACUTE (i) Function. Pediatric Acute Care Units provide care to Pediatric patients (children less than 14 years) in Pediatric nursing units on the basis of physicians' orders and approved nursing care plans. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing of dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing the patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Pediatric patients. Included in these direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients less than 14 years admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(3) 6210 PSYCHIATRIC ACUTE (i) Function. Psychiatric Acute Care Units provide care to patients admitted for diagnosis as well as treatment on the basis of physicians' orders and approved nursing care plans. The units are staffed with nursing personnel specially trained to care for the mentally ill, mentally disordered, or other mentally incompetent persons. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Psychiatric patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers. (iii) Standard Unit of Measure: number of patient days. Report patient days for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(4) 6250 OBSTETRICS ACUTE (i) Function. The provision of care to the mother following delivery on the basis of physicians' orders and approved nursing care plans is provided in the Obstetrics Acute Care Unit. Additional activities include, but are not limited to, the following:

Instructing of mothers in postnatal care and care of the newborn; serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring vital life signs; operating specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing of dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Obstetrics patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(5) DEFINITIVE OBSERVATION. (i) Function. Definitive Observation is the delivery of care to patients requiring care more intensive than that provided in the acute care areas, yet not sufficiently intensive to require admission to an intensive care area. Patients admitted to this cost center are generally transferred there from an intensive care unit after their condition has improved. The unit is staffed with specially trained nursing personnel and contains monitoring and observation equipment for intensified, comprehensive observation and care. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing dressings and cleansing wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reactions to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Definitive Observation patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data Source. The number of patient days shall be taken from daily census counts.

(6) 6290 OTHER ACUTE CARE (i) Function. Other Acute Care Units provide acute care to patients on the basis of physicians' orders and approved nursing care plans. Included are those units not required to be included in other specific Acute Care cost centers such as detoxification care (chemical dependency). Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing dressings and cleansing wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order. (ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Other Acute Care patients not required to be included in other specific Acute Care cost centers. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(b) Intensive care. (3252)

(1) 6310 MEDICAL/SURGICAL INTENSIVE CARE (i) Function. A Medical/Surgical Intensive Care Unit provides patient care of a more intensive nature than that provided to the Medical and Surgical Acute patients. The unit is staffed with specially trained nursing personnel and contains monitoring and specialized support equipment for patients who, because of shock, trauma or threatening conditions, require intensified comprehensive observation and care. Additional activities include, but are not limited, to the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing of dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering of patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing intensive daily bedside care to Medical/Surgical Intensive Care patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(2) 6330 CORONARY CARE

6331 Myocardial Infarction

6332 Pulmonary Care

6333 Heart Transplant

6339 Other Coronary Care

(i) Function. The delivery of care of a more specialized nature than that provided to the usual Medical, Surgical and Pediatric patient is provided in the Coronary Care Unit. The unit is staffed with specially trained nursing personnel and contains monitoring and specialized support or treatment equipment for patients who, because of heart seizure, open heart surgery or threatening conditions, require intensified, comprehensive observation and care. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing of dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. These cost centers contain the direct expenses incurred in providing intensive daily bedside care to Coronary Care patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to each of these units. Include the day of admission, but not the day of discharge or death. If both admissio n and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day. (iv) Data source. The number of patient days shall be taken from daily census counts.

(3) 6350 PEDIATRIC INTENSIVE CARE (i) Function. A Pediatric Intensive Care Unit provides care to children less than 14 years of age of a more intensive nature than the usual Pediatric Acute level. The units are staffed with specially trained personnel and contain monitoring and specialized support equipment for patients who, because of shock, trauma, or threatening conditions, require intensified, comprehensive observation and care. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing of equipment and assisting of physicians during patient examination and treatment; changing of dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Pediatric Intensive Care patients. Included in these direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(4) 6370 NEO-NATAL INTENSIVE CARE (i) Function. A Neo-Natal Intensive Care Unit provides care to newborn infants that is of a more intensive nature than care provided in Newborn Acute Units. Care is provided on the basis of physicians' orders and approved nursing care plans. The units are staffed with specially trained nursing personnel and contain specialized support equipment for treatment of those newborn infants who require intensified, comprehensive observation and care. Additional activities include, but are not limited to, the following:

Feeding infants; collecting sputum, urine and feces samples; monitoring vital life signs; operating specialized equipment needed for this function; preparing equipment and assisting physicians during infant examination and treatment; changing dressings or assisting physicians in changing dressings and cleansing wounds and incisions; bathing infants; observing patients for reactions to drugs; and administering specified medication; infusing fluids, including I.V.'s and blood.

(ii) Description. This cost center contains the direct expenses incurred in providing intensive daily bedside care to Neo-Natal Intensive Care patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(5) 6380 BURN CARE (i) Function. A Burn Care Unit provides care to severely burned patients that is of a more intensive nature than the usual acute nursing care provided in medical and surgical units. Burn units are staffed with specially trained nursing personnel and contain specialized support equipment for burn patients who require intensified, comprehensive observation and care. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting sputum, urine and feces samples; monitoring vital life signs; operating specialized equipment needed for this function; preparing equipment and assisting physicians during patient examination and treatment; changing dressings and cleansing wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping them into and out of bed; observing patients for reactions to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering patients' call signals; and keeping patients' rooms (personal effects) in order. (ii) Description. This cost center contains the direct expenses incurred in providing intensive daily bedside care to Burn Care patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(6) 6390 PSYCHIATRIC INTENSIVE CARE (i) Function. Psychiatric Intensive Care Units provide care to psychiatric patients which is of a more intensive nature than the usual nursing care provided in Psychiatric Acute Units. The units are staffed with specially trained nursing personnel and contain monitoring and specialized support equipment for patients who, because of shock, trauma, or threatening conditions, require intensified, comprehensive observation and care. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting of sputum, urine and feces samples; monitoring of vital life signs; operating of specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing dressings and cleansing of wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids, including I.V.'s and blood; answering patients' call signals; keeping patients' rooms (personal effects) in order.

(ii) Description. This cost center contains the direct expenses incurred in providing daily bedside care to Psychiatric Intensive Care patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of patient days. Report patient days of care for all patients admitted to this unit. Include the day of admission, but not the day of discharge or death. If both admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one patient day.

(iv) Data source. The number of patient days shall be taken from daily census counts.

(7) 6410 OTHER INTENSIVE CARE I

6420 OTHER INTENSIVE CARE II

6430 OTHER INTENSIVE CARE III

(i) General. Three zero level accounts have been established for this function to provide for the reporting of each discrete Other Intensive Care Unit separately. The designations I, II, and III do not represent levels of care. The function, description, standard unit of measure, and data source that follow apply equally to each zero level account.

(ii) Function. Other Intensive Care Units provide patient care of a more intensive nature than that provided to the Medical and Surgical Acute patients. The unit is staffed with specially trained nursing personnel and contains monitoring and specialized support equipment for patients who require intensified comprehensive observation and care. Included are those units not required to be included in other specific intensive care cost centers. Additional activities include, but are not limited to, the following:

Serving and feeding of patients; collecting sputum, urine and feces samples; monitoring vital life signs; operating specialized equipment related to this function; preparing equipment and assisting physicians during patient examination and treatment; changing dressings and cleansing wounds and incisions; observing and recording emotional stability of patients; assisting in bathing patients and helping into and out of bed; observing patients for reaction to drugs; administering specified medication; infusing fluids including I.V.'s and blood; answering patients' call signals; keeping patients' rooms (personal effects) in order.

(iii) Description. This cost center contains the direct expenses incurred in providing intensive daily bedside care to Other Intensive Care patients in those units not required to be included in other specific Intensive Care cost centers. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers. (iv) Standard Unit of Measure: number of patient days. Report

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Section 444.19 - Ambulatory services expenses description

444.19 Ambulatory services expenses description. (3260)

(a) 6710 EMERGENCY SERVICES

6711 Emergency Room

6712 Observation

6719 Other Emergency Services

(1) Function. Emergency Services provides emergency treatment to the ill and injured who require immediate medical or surgical care on an unscheduled basis. Additional activities include, but are not limited to, the following:

Comforting patients; maintaining aseptic conditions; assisting physicians in performance of emergency care; monitoring of vital life signs; applying or assisting physician in applying bandages; coordinating the scheduling of patient through required professional service functions; administering specified medications; and infusing fluids, including I.V.'s and blood.

(2) Description. This cost center contains the direct expenses incurred in providing emergency treatment to the ill and injured. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of visits. A visit is each registration of a patient in the emergency services unit of the hospital. Multiple services performed in the emergency services unit during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit. Services provided to emergency patients in ancillary cost centers are not included here, but are included in the applicable ancillary cost center.

(4) Data source. The number of visits shall be the actual count maintained by Emergency Services.

(b) 6720 CLINIC SERVICES (1) Function. Clinics provide organized diagnostic, preventive, curative, rehabilitative and educational services on a scheduled basis to ambulatory patients. The cost of therapy services such as physical therapy, speech-language pathology, occupational therapy and respiratory therapy must be reported in the appropriate ancillary cost centers. Additional activities include, but are not limited to, the following:

Participating in community activities designed to promote health education; assisting in administration of physical examinations and diagnosing and treating ambulatory patients having illnesses which respond quickly to treatment; referring patients who require prolonged or specialized care to appropriate other services; assigning patients to doctors in accordance with clinic rules; assisting and guiding volunteers in their duties; making patients' appointments through required professional service functions.

(2) Description. These cost centers contain the direct expenses incurred in providing clinic services to ambulatory patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of visits. A visit is each registration of a patient in a formally organized clinic of the hospital. Multiple services performed in the clinical unit during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit. Visits made by clinic patients to ancillary cost centers are not included here but are accumulated in the appropriate ancillary cost center.

(4) Data source. The number of visits shall be the actual count maintained by the formally organized clinic within the hospital.

(c) 6810 HOME PROGRAM DIALYSIS EQUIPMENT-100%

(1) Function. This cost center provides medically necessary dialysis equipment for dialysis patients capable of administering their own treatment in their homes. The cost center provides, obtains, or arranges for the provision of:

(i) artificial kidney and automated peritoneal dialysis machines, including supportive equipment such as blood pumps, heparin pumps, bubble detectors and other alarm systems. (Supportive equipment does not include items not used in conjunction with delivery systems, such as scales, blood pressure apparatus and other diagnostic devices);

(ii) dialysis equipment installation, maintenance and repair; and

(iii) dialysis equipment reconditioning for subsequent use.

Hospitals so electing will be reimbursed by the Medicare program 100 percent of the reasonable costs incurred by the provision of such home dialysis equipment. Additional activities include, but are not limited to, the following: Water testing; making minor plumbing and electrical changes to accommodate the equipment; delivering the equipment; replacing water filters on reverse osmosis devices; providing minor parts to the patient for patient-performed maintenance; transporting equipment for installation and reconditioning. (2) Description. This cost center contains the direct expenses incurred in providing dialysis equipment, for patients dialyzing at home, for which the hospital will be reimbursed 100 percent of the reasonable cost. Included as direct expenses are: Salaries and wages, employee benefits, professional fees, supplies, purchased services, and other direct expenses. As an exception to the requirement to report all equipment maintenance expense in the Plant Operations and Maintenance cost center, dialysis equipment maintenance expense must be reported in this cost center.

(3) Standard Unit of Measure: number of patient months. Count as one, each month or major portion thereof, each home dialysis patient who is in the 100 percent reimbursement home dialysis program.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(d) 6820 HOME PROGRAM DIALYSIS-OTHER

(1) Function. The Home Program Dialysis-Other cost center provides home dialysis support services for dialysis patients capable of administering their own treatment in their home. This program obtains or arranges for the provision of:

(i) medically necessary dialysis equipment as prescribed by the attending physician;

(ii) dialysis equipment installation, maintenance and repair services;

(iii) all necessary medical supplies; and

(iv) the services of trained home dialysis aides, where necessary.

Additional activities include, but are not limited to, the following: Periodic monitoring of patient's home adaption to self-dialysis in accordance with patient care plans; home visits by qualified provider personnel; testing and appropriate treatment of water.

(2) Description. This cost center contains the direct expenses incurred in providing home program dialysis services to self-care home dialysis patients other than such expenses included in account 8810, Home Program Dialysis Equipment--100%. As an exception to the requirement to report all patient-chargeable supplies in the Medical Supplies Sold cost center (account 7110), home program dialysis patient-chargeable supplies are to be included in this cost center.

(3) Standard Unit of Measure: number of patient months. Count as one, each month or major portion thereof, each home dialysis patient who is in the home dialysis program. These patients are those not in the 100 percent reimbursement home dialysis program.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(e) 6830 AMBULATORY SURGERY SERVICES (1) Function. Ambulatory Surgery Services are those surgical services provided to outpatients in a discrete outpatient surgical suite by specially trained nursing personnel who assist physicians in the performance of surgical and related procedures both during and immediately following surgery. Additional activities include, but are not limited to, the following:

Comforting patients in the operating room; maintaining aseptic techniques; scheduling operations in conjunction with surgeons; assisting surgeon during operations; preparing for operations; cleaning up after operations to the extent of preparation for pickup and disposal of used linen, gloves, instruments, utensils, equipment and waste; arranging sterile setup for operation; assisting in preparing patients for surgery; inspecting, testing and maintaining special equipment related to this function; preparing patient for transportation to recovery room; counting sponges, needles and instruments used during operation; enforcing safety rules and standards; monitoring patient while recovering from anesthesia.

(2) Description. This cost center contains the direct expenses associated with a separately identifiable outpatient surgery room. When a common operating room is used for both inpatients and outpatients, the direct costs for both must be accumulated in the "Operating Room" (account 7040). Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of surgery minutes. Surgery minutes are the difference between starting time and ending time, defined as follows:

Starting time is the beginning of anesthesia administered in the room in which the procedure is to be performed (or surgery if anesthesia is not administered or if anesthesia is administered in other than the operating room). Ending time is the end of surgery.

(4) Data source. The number of surgery minutes shall be an actual count obtained from the surgery room operating log.

(f) 6840 PSYCHIATRIC DAY AND NIGHT CARE SERVICES (1) Function. The Psychiatric Day and Night Care Services provides intermittent care to patients, either during the day with the patient returning to his home each night, or during the evening and night hours with the patient performing his usual daytime functions. (2) Description. This cost center contains all the direct expenses of maintaining Psychiatric Day and Night Care Services. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of visits. A visit is each registration of a patient in a formally organized Psychiatric Day and Night Care unit of the hospital. Multiple services performed in the Psychiatric Day and Night Care unit during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit.

(4) Data source. The number of visits shall be the actual count maintained by the Psychiatric Day and Night Care Services unit.

(g) 6850 AMBULANCE SERVICES (1) Function. This cost center provides ambulance service to the ill and injured who require medical attention on a scheduled and an unscheduled basis. Additional activities include, but are not limited to, the following:

Lifting and placing patient into and out of an ambulance; transporting patients to and from the hospital; first aid treatment administered by a physician or paramedic prior to arrival at the hospital.

(2) Description. The cost center contains the direct expenses incurred in providing ambulance service to the ill and injured. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of occasions of service. Ambulance service provided a patient is counted as one occasion of service regardless of special services rendered at the point of pickup or during transport. For example, the administration of oxygen and first aid during the pickup and delivery of the patient would not be counted as a separate occasion of service.

(4) Data source. The number of occasions of service shall be the actual count maintained by Ambulance Services.

(h) 6860 OTHER AMBULATORY SERVICES (1) Description. This cost center contains the direct expenses incurred in maintaining ambulatory services not specifically required to be included in Emergency Services, Clinic Services, Home Program Dialysis, Ambulatory Surgery Services, Psychiatric Day and Night Care Services, Ambulance Services, Free Standing Clinics Services, or Home Health Services cost centers. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(2) Standard Unit of Measure: none required. Not applicable.

(i) 6870 FREE STANDING CLINIC I

6880 FREE STANDING CLINIC II

6890 FREE STANDING CLINIC III

(1) General. Three zero level accounts have been established for this function to provide for the reporting of up to three discrete Free Standing Clinics. The designations I, II and III do not indicate the level of care. The function, description, standard unit of measure and date source below apply to each Free Standing Clinic.

(2) Function. Free Standing Clinics provide organized diagnostic, preventive, curative, rehabilitative and educational services on a scheduled basis to ambulatory patients at locations other than on the hospital grounds. The cost of therapy services such as physical therapy, speech-language pathology, occupational therapy and respiratory therapy must be reported in the appropriate ancillary cost centers. Additional activities include, but are not limited to, the following:

Participating in community neighborhood activities designed to promote health education; assisting in administration of physical examinations and diagnosing and treating ambulatory patients having illnesses which respond quickly to treatment; referring patients who require prolonged or specialized care to appropriate other services; assigning patients to doctors in accordance with clinic rules; assisting and guiding volunteers in their duties; making patients' appointments through required professional service functions.

(3) Description. This cost center contains the direct expenses incurred in providing clinic services to ambulatory patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other expenses, and transfers.

(4) Standard Unit of Measure: number of visits. A visit is each registration of a patient in a free standing clinic of the hospital. Multiple services performed in a free standing clinic during a single registration (e.g., encounters with two or more physicians, two or more occasions of service, any combination of one or more encounters and occasions of service) are recorded as one visit. (5) Data source. The number of visits shall be the actual count maintained by the free standing clinics.

(6) Effective date. The reporting of Free Standing Clinic II (account 6880) and Free Standing Clinic III (account 6890) is optional for cost reporting periods beginning in 1980. For cost reporting periods beginning in 1981 and thereafter, reporting these cost centers separately is required.

(j) 6910 HOME HEALTH--SKILLED NURSING CARE (1) Function. Home Health--Skilled Nursing Care is part-time or intermittent nursing care provided by or under the direct supervision of a licensed nurse (R.N., L.P.N. or L.V.N.) to patients in their residence on the basis of physician's orders and an approved plan of care established and periodically reviewed by the physician. It consists of care in which the patients require convalescent and/or major restorative services at a level less intensive than institutional requirements. Activities include, but are not limited to, the following: Administration of parenteral medication (e.g., intravenous and intramuscular injections or insertion of catheter); changing of dressings and cleansing of wounds; irrigations; enemas; colostomy care; urethral catheter care; administration of oxygen and certain drugs through inhalation of positive pressure; vital signs; observing and recording psychiatric symptoms.

(2) Description. This cost center contains the direct expenses incurred in the provision of skilled nursing care to patients normally at their place of residence. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(3) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If a visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--i.e., two or more visits (see Example 3).

(i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(k) 6920 HOME HEALTH SERVICES--MEDICAL SOCIAL SERVICES (1) Function. Home Health--Medical Social Services is the provision of counseling and assessment activities which contribute meaningfully to the treatment of a patient's condition. These services must be under the direction of a physician and must be given by or under the supervision of a qualified medical or psychiatric social worker. Such services include, but are not limited to, the following: assessment of the social and emotional factors related to the patient's illness, his need for care; his response to treatment and his adjustment to care; appropriate action to obtain casework services to assist in resolving problems in these areas; assessment of the relationship of the patient's medical and nursing requirements to his home situation, his financial resources, and the community resources available to him.

(2) Description. This cost center contains the direct expenses incurred in the provision of Medical Social Services within the context of Home Health Care. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(3) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--i.e., two or more visits (see Example 3). (i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(l) 6930 HOME HEALTH SERVICES--HOME HEALTH AIDES (1) Function. Home Health Aides Services is the provision of personal care services under the supervision of a registered professional nurse and, if appropriate, a physical, speech or occupational therapist or other qualified person. This function is performed by specially trained personnel who assist individuals in carrying out physicians' instructions and established plans of care. Additional services include, but are not limited to, the following: assisting the patient with activities of daily living (helping to bathe, to get in and out of bed, to care for hair and teeth, to exercise, to take medications specially ordered by a physician which are ordinarily self-administered); assisting the patient with necessary self-help skills.

(2) Description. This cost center contains the direct expenses incurred in the provision of Home Health Aide services. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(3) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--i.e., two or more visits (see Example 3).

(i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(4) Data source. Departmental records.

(5) Effective date. Reporting periods beginning in 1980 and thereafter.

(m) 6990 HOME HEALTH SERVICES--OTHER HOME HEALTH (1) Description. This cost center is used to report home health patient care services not specifically required to be reported in Home Health--Skilled Nursing Care (account 6910), Home Health--Medical Social Services (account 6920) and Home Health Aides (account 6930). Such services include nutritional services, homemaker services and private duty nursing. The cost of therapy services such as physical therapy, speech-language pathology, occupational therapy and respiratory therapy must be reported in the appropriate ancillary cost centers. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses.

(2) Standard Unit of Measure: number of home visits. A home visit is a personal contact in the place of residence of a patient made for the purpose of providing a service by a member of the staff of the home health agency or by others under contract or arrangement with the home health agency. Visits by therapists are not included here but in the appropriate ancillary cost center. If visit is made simultaneously by two or more persons from the home health agency to provide a single service, for which one person supervises or instructs the other, it is counted as one visit (see Example 1). If one person visits the patient's home more than once during a day to provide services, each visit is recorded as a separate visit (see Example 2). If a visit is made by two or more persons from the home health agency for the purpose of providing separate and distinct types of services, each is recorded--l.e., two or more visits (see Example 3). (i) Example 1. If two nurses visit the patient together to provide nursing services and one is there to supervise the other, one visit is counted.

(ii) Example 2. If a nurse visits the patient in the morning to dress a wound and later must return to replace a catheter, two visits are counted. However, if the nurse visits the patient in the morning to dress a wound and to replace a catheter, one visit is counted.

(iii) Example 3. If a nurse visits the patient to replace a catheter and at the same time the patient is visited by a home health aide to provide home health aide services, two visits are counted.

(3) Data source. Departmental records.

(4) Effective date. Reporting periods beginning in 1980 and thereafter.
 

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Section 444.20 - Ancillary services expenses description

444.20 Ancillary services expenses description. (3270)

(a) 7010 LABOR AND DELIVERY SERVICES (1) Function. Labor and Delivery services are provided by specially trained personnel to patients in Labor and Delivery, including prenatal care in labor, assistance in delivery, postnatal care in recovery, and minor gynecological procedures, if performed in the Delivery suite. Additional activities include, but are not limited to, the following:

Comforting patients in the labor and delivery and recovery rooms; maintaining aseptic techniques; preparing for deliveries and surgery; cleaning up after deliveries to the extent of preparation for pickup and disposal of used linen, gloves, instruments, utensils, equipment and waste; arranging sterile setup for deliveries and surgery; preparing patient for transportation to delivery room and recovery room; enforcing of safety rules and standards; monitoring of patients while in recovery.

(2) Description. This cost center contains the direct expenses incurred in providing care to maternity patients in labor, delivery, and recovery rooms. Included as direct expenses are: salaries and wages, employee benefits, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: number of procedures. Report multiple births as one procedure. Include Caesarean sections only when they are performed in delivery room. Caesarean sections performed in the Surgical suite shall be included in the operating room statistics. Stillbirths are counted as procedures. Infants born outside the hospital building are not to be classified as a procedure unless care was rendered in the Labor and Delivery Services. Whenever obstetrical and gynecological procedures such as abortions, D & C's, etc. are performed in Labor and Delivery, each procedure performed is counted as one.

(4) Data source. The number of procedures shall be an actual count obtained from medical records, or as maintained by Labor and Delivery.

(b) Surgical Services Group.

(1) 7040 SURGERY SERVICES

7041 General Surgery

7042 Open Heart Surgery

7043 Neurosurgery

7044 Orthopedic Surgery

7045 Kidney Transplant

7046 Other Organ Transplants

7049 Other Operating Room Services

(i) Function. Surgical Services are provided to inpatients, and outpatients if the hospital uses a common operating room for both inpatients and outpatients, by physicians and specially trained nursing personnel who assist physicians in the performance of surgical and related procedures during and immediately following surgery. Additional activities include, but are not limited to, the following:

Comforting patients in the operating room; maintaining aseptic techniques; scheduling operations in conjunction with surgeons; assisting surgeon during operations; preparing for operations; cleaning up after operations to the extent of preparation for pickup and disposal of used linen, gloves, instruments, utensils, equipment and waste; assisting in preparing patients for surgery; inspecting, testing and maintaining special equipment related to this function; preparing patient for transportation to recovery room; counting of sponges, needles and instruments used during operation; enforcing of safety rules and standards.

(ii) Description. These cost centers contain the direct expenses incurred in providing surgical services to patients. When a common operating room is used for both inpatients and outpatients, the direct costs for both are to remain in this cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of surgery minutes.Surgery minutes is the difference between starting time and ending time, defined as follows:

Starting time is the beginning of anesthesia administered in the room in which the procedure is to be performed (or surgery if anesthesia is not administered or if anesthesia is not administered in the operating room). Ending time is the end of surgery.

(iv) Data source. The number of surgery minutes shall be an actual count obtained from the operating room log.

(2) 7060 RECOVERY SERVICES (i) Function. Recovery Services are provided by specially trained personnel immediately following surgery, including monitoring of patients while recovering from anesthesia. Additional activities include, but are not limited to, the following:

Comforting patients in the recovery room, maintaining aseptic techniques, monitoring of vital life signs, operating of specialized equipment related to this function, administering specified medication, observing patient's condition until all effects of the anesthesia have passed, preparing patient for transportation to acute care or intensive care units. (ii) Description.This cost center contains the direct expenses incurred in monitoring of patients while recovering from anesthesia. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of recovery room minutes. Recovery room minutes is the difference between time of admission to recovery room and time of discharge from the unit.

(iv) Data source. The number of recovery room minutes shall be an actual count maintained by the recovery room.

(3) 7080 ANESTHESIOLOGY (i) Function. Anesthesia services are rendered in the hospital by, or under the direction of, either a physician trained in anesthesia or the operating surgeon. Additional activities include, but are not limited to, the following:

Recording kind and amount of anesthetic administered; conducting physical examination of patients; observing patient's condition until all effects of the anesthesia have passed; obtaining laboratory findings before anesthetic is administered; administering treatment to patients having symptoms of post-anesthetic complication; accompanying patient to recovery room or Intensive care unit; prescribing pre- and post-anesthesia medication; establishing and carrying out safeguards for administration of anesthetics.

(ii) Description. This cost center contains the direct expenses incurred in administering anesthetics under the direction of a physician. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of anesthesia minutes.Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that Is, when the patient may be placed under post-operative supervision.

(iv) Data source. The number of anesthesia minutes shall be an actual count maintained by the Anesthesiology cost center.

(c) Medical Supplies and Equipment Group.

(1) 7110 MEDICAL SUPPLIES SOLD (i) Description. The Medical Supplies Sold cost center is used for the accumulation of the invoice cost of all medical and surgical supplies sold directly to patients. The invoice/inventory cost of non-chargeable supplies and equipment issued by the Central Services and Supplies cost center (Account 8460) to other cost centers shall be reported in the using cost centers. If medical and surgical supplies are sold in other hospital cost centers, the cost of those items must be reported in to this cost center. The overhead cost of preparing and issuing medical and surgical supplies and equipment sold directly to patients must be reported in the Central Services and Supplies cost center (account 8460). The applicable portion of such overhead will be allocated to this cost center during the cost allocation process. The cost of reusable patient chargeable supplies must be reported in the Central Services and Supplies cost center. Do not report in this cost center the cost of durable medical equipment sold, leased or rented. Such costs are to be reported in accounts 7130 and 7140, Durable Medical Equipment--Sold, and Durable Medical Equipment--Leased/Rented, respectively.

(ii) Standard unit of measure: none required; not applicable.

(iii) Effective date. Relative to the separation of Durable Medical Equipment (accounts 7130 and 7140) from this cost center, the effective date is cost reporting periods beginning in 1982 and thereafter.

(2) 7130 DURABLE MEDICAL EQUIPMENT--SOLD

(i) Description. The Durable Medical Equipment--Sold cost center is used to report the invoice/inventory costs of all durable medical equipment sold directly to patients. Durable Medical Equipment includes but is not limited to: hospital beds, wheelchairs, trapeze bars, oxygen tents, intermittent positive breathing machines, etc. Include in the appropriate Home Program Dialysis cost center the cost of dialysis and supportive equipment sold. The overhead cost of preparing and issuing durable medical equipment sold directly to patients and others must be reported in the Central Services and Supplies cost center (account 8460).

(ii) Standard unit of measure; none required; not applicable.

(iii) Effective date. Reporting periods beginning in 1982 and thereafter.

(3) 7140 DURABLE MEDICAL EQUIPMENT--LEASED/RENTED

(i) Description. The Durable Medical Equipment--Leased/Rented cost center is used to report depreciation expenses related to the Durable medical equipment leased or rented directly to patients and others. Durable medical equipment includes but is not limited to: hospital beds, wheelchairs, trapeze bars, crutches, canes, oxygen tents, intermittent positive breathing machines, exercycles, heat lamps, flotation mattresses, bed baths, etc. Include home program dialysis equipment and support in the appropriate Home Program Dialysis cost center. The overhead cost of preparing and issuing durable medical equipment leased and rented to patients and others must be reported in the Central Services and Supplies cost center (account 8460). (ii) Standard Unit of Measure; none required; not applicable.

(iii) Effective date. Reporting periods beginning in 1982 and thereafter.

(d) 7150 DRUGS SOLD (1) Description. The Drugs Sold cost center is used for the accumulation of the invoice/inventory cost of all pharmaceuticals, intravenous solutions and blood derivatives sold directly to patients. The invoice/inventory cost of non-chargeable drugs (pharmaceuticals, blood derivatives and I.V. solutions) issued by the Pharmacy (account 8470) to other cost centers shall be reported in the using cost centers. If such items are sold in other cost centers, the cost of those items must be transferred to this cost center. The overhead cost of preparing and issuing drugs sold directly to patients must be accumulated in the Pharmacy cost center (account 8470). The applicable portion of such overhead will be allocated to this cost center during the cost allocation process.

(2) Standard Unit of Measure: none required; not applicable.

(e) Laboratory Services Group.

(1) 7210 LABORATORY SERVICES-CLINICAL

7211 Chemistry

7212 Hematology

7213 Immunology (Serology)

7214 Microbiology (Bacteriology)

7215 Procurement and Dispatch

7216 Urine and Feces

7219 Other Clinical Laboratories

(i) Function. These cost centers perform diagnostic and routine clinical laboratory tests necessary for the diagnosis and treatment of hospital patients. Additional activities include, but are not limited to, the following:

Transporting specimens from nursing floors and operating rooms; drawing of blood samples; caring for laboratory animals and equipment; maintaining quality control.

(ii) Description. These cost centers contain the direct expenses incurred in the performance of laboratory tests necessary for diagnosis and treatment. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition). In recording Workload Measurement Units, workload units related to quality control standards, calibration standards and specimen collection, duplicates and repeats for which a patient is not charged are not to be counted. Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel. Workload measurement units shall be maintained and reported for laboratory services obtained from outside laboratories.

(iv) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory.

(2) 7230 LABORATORY SERVICES-PATHOLOGICAL

7231 Cytology

7232 Histology

7233 Autopsy

7239 Other Pathological Laboratories

(i) Function. These cost centers perform diagnostic and routine laboratory tests on tissues and cultures necessary for the diagnosis and treatment of hospital patients. Additional activities include, but are not limited to, the following:

Mortuary operation, autopsy; transportation of specimens from nursing floors and operating rooms; care of laboratory animals and equipment; maintenance of quality control standards; preparation of samples for testing.

(ii) Description. These cost centers contain the direct expenses incurred in the performance of diagnostic and routine tests on tissues and cultures. included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition). In recording Workload Measurement Units, workload units related to quality control studies, calibration standards and specimen collection, and repeats for which a patient is not charged, are not to be counted. Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel. Workload measurement units shall be maintained and reported for laboratory services obtained from outs ide laboratories.

(iv) Data source. The number of workload measurement units shall be an actual count maintained by the laboratory.

(3) 7250 WHOLE BLOOD AND PACKED RED CELLS (i) Function. This cost center procures and collects whole blood and packed red cells. Also included in the recruitment of donors.

(ii) Description. This cost center contains the direct expense incurred in procuring whole blood and packed red cells, drawing blood and recruiting and paying donors. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses. Do not include in this cost center the expenses incurred in performing tests on blood (i.e., typing, crossmatching, etc.). These expenses must be reported in Laboratory Services--Clinical (account 7210). The cost of blood derivatives is to be reported in account 7150, Drugs Sold (if the patient is charged), or the using cost center (if the patient is not charged). The cost of blood (amount paid or fair market value) is reported in this cost center, or an inventory account if applicable, rather than netted against revenue or cleared through an agency account. When blood is purchased, cost is the amount paid. The service fee charged by the outside blood sources is not reported here but reported in Blood Processing and Storing (account 8480). When blood is donated, cost is its fair market value at the date of donation and an offsetting amount is reported in Donated Blood (account 5770).

If replacement blood is received by the hospital blood bank, the original amount charged the patient is reported in this cost center and removed from the patient's account (Accounts and Notes Receivable, account 1030).

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition).

(iv) Data Source. The number of workload measurement units shall be an actual count maintained by this cost center.

(4) 7260 BLOOD PROCESSING AND STORING (i) Function. This cost center processes, preserves, stores, and issues whole blood and packed red cells after it has been procured. Additional activities include, but are not limited to, the following:

Plasma fractionation; freezing and thawing blood; maintaining inventory control.

(ii) Description. This cost center contains the direct expenses incurred in processing, storing, and issuing whole blood and packed red cells after it has been procured. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services and other direct expenses. Include in this cost center the cost of spoiled or defective blood, and the service fee charged by outside blood sources, whether or not the blood is replaced. Do not include in this cost center the expenses incurred in performing tests on blood (i.e., typing, cross-matching, etc.). These expenses must be reported in Laboratory Services--Clinical (account 7210). `The cost of blood and packed red cells must be reported in the Whole Blood and Packed Red Cells cost center (account 7250). The cost of blood derivatives must be in the Drugs Sold cost center (account 7250) if the patient is charged, or the using cost center if the patient is not charged.

(iii) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition).

(iv) Data source. The number of workload measurement units shall be an actual count maintained by this cost center.

(f) 7290 ELECTROCARDIOGRAPHY (1) Function. This cost center operates specialized equipment to record graphically electromotive variations in actions of the heart muscle; record graphically the direction and magnitude of the electrical forces of the heart's action; and/or record graphically the sounds of the heart for diagnostic purposes. Additional activities include, but are not limited to, the following:

Wheeling portable equipment to patients' bedside; explaining test procedures to patient; operating specialized equipment; inspecting, testing and maintaining special equipment; attaching and removing electrodes from patient.

(2) Description. This cost center contains the direct expenses incurred in performing electrocardiographic examinations. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(3) Standard Unit of Measure: workload measurement units. Laboratory Workload Recording Method, published by College of American Pathologists (use the latest edition). Workload units for unlisted procedures should be reasonably estimated based upon work units for other comparable procedures, or estimated by qualified personnel.

(4) Data source. The number of workload measurement units shall be an actual count maintained by this cost center.

(g) 7310 CARDIAC CATHETERIZATION LABORATORY (1) Function. The Cardiac Catheterization Laboratory provides special diagnostic procedures such as catheterization required for care of patients with cardiac conditions.

(2) Description. This cost center shall contain the direct expenses incurred in providing cardiac catheterization diagnostic examinations. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(3) Standard Unit of Measure: number of procedures. Count each cardiac catheterization procedure for which a charge is made as one procedure.

(4) Data source. The number of procedures shall be the actual count maintained by the Cardiac Catheterization Laboratory. (h) Radiology Services Group.

(1) 7320 RADIOLOGY--DIAGNOSTIC

7321 Angiocardiography

7322 Ultrasonography

7339 Radiology--Diagnostic--Other

(i) Function. This cost center provides diagnostic radiology services as required for the examination and care of patients under the direction of a qualified radiologist. Diagnostic radiology services include the taking, processing, examining and interpreting of radiography, ultrasonograms, and fluorographs. Additional activities include, but are not limited to, the following:

Consultation with patients and attending physician; radioactive waste disposal; storage of radioactive materials.

(ii) Description. This cost center contains the direct expenses incurred in providing diagnostic radiology services. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies. purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: relative value units. Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies. Relative value units for unlisted and "BR" (By Report) procedures should be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. (Count "Total Unit Value", not "PC Unit Value".)

(iv) Data source. The number of relative value units shall be the actual count maintained by the Radiology--Diagnostic cost center.

(2) 7340 CT SCANNER (i) Function. The CT (computed tomographic) Scanner function provides computed tomographic scans of the head and other parts of the body.

(ii) Description. This cost center shall contain the direct expenses incurred in providing CT scans. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: number of procedures. Count each computed tomographic scanner procedure as one procedure. Count only those procedures which are charged for. A patient procedure is defined as the initial scan and any additional scans of the same anatomical area during a single visit.

(iv) Data source. The number of procedures shall be the actual count maintained by the CT Scanner cost center.

(3) 7360 RADIOLOGY--THERAPEUTIC (i) Function. This cost center provides therapeutic radiology services as required for the care and treatment of patients under the direction of a qualified radiologist. Therapeutic radiology services include therapy by radium and radioactive substances. Additional activities include, but are not limited to, the following:

Consultation with patients and attending physician; radioactive waste disposal; storage of radioactive materials.

(ii) Description. This cost center contains the direct expenses incurred in providing therapeutic radiology services. Included in these direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses, and transfers.

(iii) Standard Unit of Measure: relative value units. Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Values Studies. Relative value units for unlisted and "BR" (By Report) procedures should be reasonably estimated on the basis of other comparable procedures or estimates by qualified personnel. (Count "Total Unit Value", not "PC Unit Value".)

(iv) Data source. The number of relative value units shall be the actual count maintained by the Radiology--Therapeutic cost center.

(4) 7380 NUCLEAR MEDICINE

7381 Nuclear Medicine--Diagnostic

7382 Nuclear Medicine--Therapeutic

(i) Function. This cost center provides diagnosis and treatment

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Section 444.21 - Other operating expenses description

444.21 Other operating expenses description. (3280)

(a) Research Expenses (3281)

(1) 8010 RESEARCH. (i) Function. This cost center administers, manages, and carries on research projects funded by outside donations, grants and/or the hospital. Additional activities include: Maintenance of animal house and administration of specific research projects.

(ii) Description. This cost center contains the direct expenses incurred in overseeing all research and in carrying on research in the hospital. Separate cost centers should be maintained for each research activity for which separate accounting is required, either by a grant agreement, contract, or because of restrictions made upon donations. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(b) Education Expense (3282)

(1) 8220 NURSING EDUCATION

8221 Registered Nurses

8222 Licensed Vocational (Practical) Nurses

(i) Function. Hospitals may either operate a School of Nursing or provide the clinical training activities for student nurses when the degree is issued by a college or university. Nursing Education is a school for educating Registered Nurses and/or Licensed Vocational (Practical) Nurses. Additional activities include, but are not limited to, the following:

Selecting qualified nursing students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; selecting faculty personnel; assigning and supervising students in giving nursing care to selected patients; and administering aptitude and other tests for counseling and selection purposes.

(ii) Description. This cost center shall be used to record the direct expenses incurred in, or providing clinical facilities for, the education of Registered Nurses and/or Licensed Vocational (Practical) Nurses. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: number of FTE nursing students. The number of FTE nursing students in the Nursing Education cost center is defined as the sum of the percentage of time each student nurse is enrolled in the school during the year divided by 100.

(iv) Data source. The number of FTE nursing students in this educational program shall be the actual count maintained by the Nursing Education cost center.

(2) 8240 POSTGRADUATE MEDICAL EDUCATION--APPROVED

PRIMARY TEACHING PROGRAM--INTERNAL MEDICINE

8250 POSTGRADUATE MEDICAL EDUCATION--APPROVED

PRIMARY TEACHING PROGRAM--FAMILY PRACTICE

8260 POSTGRADUATE MEDICAL EDUCATION--APPROVED

PRIMARY TEACHING PROGRAM--PEDIATRICS

8270 POSTGRADUATE MEDICAL EDUCATION--OTHER

APPROVED TEACHING PROGRAMS

(i) Function. A Postgraduate Medical Education Teaching Program provides an organized program of postgraduate medical clinical education to interns and residents. To be approved, a medical internship or residency training program must be approved by the Council on Medical Education of the American Medical Association or, in the case of an osteopathic hospital, approved by the Committee on Hospitals of the Bureau of Professional Education of the American Osteopathic Association. Intern or residency programs in the field of dentistry in a hospital or osteopathic hospital must have the approval of the Council on Dental Education of the American Dental Association. Additional activities include, but are not limited to, the following:

Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; and assigning and supervising students.

(ii) Description. This cost center shall be used to record the direct expenses incurred in providing an approved organized program of postgraduate medical clinical education. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers. All salaries and stipends paid to interns and residents in approved teaching programs must be reflected in this cost center, in the "Salaries and Wages" natural expense classification (.07).

(iii) Standard Unit of Measure: number of FTE students. The number of FTE students in Postgraduate Medical Education Approved programs is defined as the sum of the percentage of time each student is enrolled in such programs during the year divided by 100. (iv) Data source. The number of FTE students in these educational programs shall be the actual count maintained in each such program.

(v) Effective dates. For the reporting of accounts 8240 through 8270, relative to approved teaching programs, cost reporting periods beginning on or after January 1, 1981. The Standard Unit of Measure (FTE students) for accounts 8240 through 8260 must be collected beginning July 1, 1981. For cost reporting periods beginning in 1980, report all Approved Postgraduate Medical Education programs (including the Standard Unit of Measure) under account 8270.

(8) 8280 POSTGRADUATE MEDICAL EDUCATION--NON-APPROVED TEACHING PROGRAM (i) Function. A Postgraduate Medical Education program provides an organized program of postgraduate medical clinical education to interns and residents. To be non-approved means that a medical internship or residency training program is not approved by the Council on Medical Education of the American Medical Association or, in the case of an osteopathic hospital, is not approved by the Committee on Hospitals of the Bureau of Professional Education of the American Osteopathic Association. Intern or residency programs in the field of dentistry in a hospital or osteopathic hospital are non-approved unless the approval of the Council on Dental Education of the American Dental Association has been received. Additional activities include, but are not limited to, the following: Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems, and assigning and supervising students.

(ii) Description. This cost center shall be used to record the direct expenses incurred in providing an organized program of postgraduate medical clinical education. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers. All salaries or stipends paid to interns and residents in non-approved teaching programs must be reflected in this cost center, in the "Salaries and Wages" natural expense classification (.07).

(iii) Standard Unit of Measure: number of FTE students. The number of FTE students in Postgraduate Medical Education Non-Approved programs is defined as the sum of the percentage of time each student is enrolled in such programs during the year divided by 100.

(iv) Data source. The number of FTE students in these educational programs shall be the actual count maintained by each such program.

(4) 8290 OTHER HEALTH PROFESSION EDUCATION

8291 School of Medical Technology

8292 School of X-Ray Technology

8293 School of Respiratory Therapy

8294 Administrative Intern Program

8295 Medical Records Librarian Program

(i) Function. Other Health Profession Education is the provision of organized programs of medical clinical education other than for nurses (RN and LVN) and doctors, and the provision of organized education programs for administrative interns and externs, Medical Records Librarians, and other health professionals. Additional activities include, but are not limited to, the following:

Selecting qualified students; providing education in theory and practice conforming to approved standards; maintaining student personnel records; counseling of students regarding professional, personal and educational problems; selecting faculty personnel; assigning and supervising students in giving medical care to selected patients; and administering aptitude and other tests for counseling and selection purposes.

(ii) Description. These cost centers contain the direct expenses relative to operating health education programs other than nursing and postgraduate medical programs, such as a School of Medical Technology, School of X-Ray Technology, School of Respiratory Therapy, and other non-inservice education programs such as those listed above. A separate cost center should be established for each program. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: number of FTE students. The number of FTE students in Other Health Profession Education programs is defined as the sum of the percentage of time each student is enrolled in an Other Health Profession Education Program during the year divided by 100.

(iv) Data source. The number of FTE students in such programs shall be the actual count maintained by each such program. (c) General Services. (3283)

(1) 8310 DIETARY SERVICES (i) Function. Dietary Services includes the procurement, storage, processing and delivery of food and nourishments to patients in compliance with Public Health regulations and physicians' orders. Additional activities include, but are not limited to, the following:

Nutritional assessment;

Teaching patients and their families nutrition and modified diet requirements; determining patient food preferences as to type and method of preparation; preparing selective menus for various specific diet requirements; preparing or recommending a diet manual, approved by the medical staff, for use by physicians and nurses; and delivering food trays to, and collecting food trays from, patient service areas for meals and nourishments; and incidental activities such as cleaning up of spills in preparing food.

(ii) Description. This cost center contains the direct expenses incurred in preparing food for patients and delivering food to patient service areas. Infant formula must be reported in the using cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, and other direct expenses. Also included is Dietary Service's share of common costs of the Non-Patient Food Service and Dietary Services cost centers.

Examples of common costs include: salaries of cooks who prepare food for both cost centers, common food costs, common minor equipment costs, if expensed, common administrative costs, etc. These common costs shall be distributed to the Dietary and Non-Patient Food Service cost centers, based upon the ratio of number of meals served in each cost center. A detailed explanation of the method to be used in computing the number of non-patient meals served by the Non-Patient Food Service cost center is included in the explanation of the Non-Patient Food Service Standard Unit of Measure.

(iii) Standard Unit of Measure: number of patient meals. Count only regularly scheduled meals (3-meal schedules only) and exclude snacks and fruit juices served between regularly scheduled meals. Also excluded are tube feedings and infant formula.

(iv) Data source. The number of patient meals must be the actual count of patient meals maintained by the Dietary cost center.

(2) 8320 NON-PATIENT FOOD SERVICE (i) Function. Non-Patient Food Service includes the procurement, storage, processing and delivery of food to employees and other non-patients in compliance with Public Health regulations.

(ii) Description. This cost center contains all directly identifiable expenses incurred in preparing and delivering food to employees and other non-patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, and other direct expenses. Also included is the Non-Patient Food Service's share of common costs of the Non-Patient Food Service and Dietary Services cost centers. The cost of edible supplies for vending machines serviced by the health facility must be included in this cost center. Vending machine revenue is to be included in other operating revenue account 5820 (Vending Machine Commissions).

(iii) Standard Unit of Measure: equivalent number of meals served. To obtain an equivalent meal in a pay cafeteria, divide total Non-Patient Food Service revenue by the average selling price of a full meal. The average full meal should include meat, potato, vegetable, salad, beverage and dessert. When there is a selection of entrees, desserts and so forth, that are available at different prices, use an average in calculating the selling price of a full meal. Count a free meal served as a full meal.

(iv) Data source. Non-Patient Food Service revenue must be taken from the general ledger.

(3) 8330 LAUNDRY AND LINEN (i) Function. Laundry and Linen activities include picking up, storing, issuing, mending, washing, distributing and processing of in-service linens. The services include uniforms, special linens and disposable linen substitutes.

(ii) Description. This cost center shall contain the direct expenses incurred in providing laundry and linen services for hospital use, including student, nonpaid worker, and employee quarters. Cost of disposable linen must be recorded in this cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: number of dry and clean pounds processed. Record the weight of linen processed (laundered and dried) plus the equivalent weight of disposable linen substitutes used. Linen is weighed after it has been cleaned and processed. Include uniforms and linen from personnel quarters and employee housing. If linen is not weighed, a conversion from pieces to pounds is allowed. If soiled linen is weighed, divide by 1.1. (iv) Data sour ce. The number of dry and clean pounds processed (laundered and dried) must be taken from actual counts maintained in the Laundry and Linen cost center. If the hospital uses an outside laundry service, the number of dry and clean pounds processed must be maintained and reported.

(4) 8350 SOCIAL SERVICES (i) Function. The Social Work Services cost center obtains, analyzes, and interprets psychosocial, environmental and economic information to assist in diagnosis, treatment and rehabilitation of patients. These services include: counseling of patients an families in individual and group units; collaboration with health care staff; mobilizing resources on behalf of patients both within a given hospital and in various agencies outside the hospital; and participation in the development of social and health programs in the community. Other tasks involve collecting and revising information on community health and welfare resources, departmental management and being accountable to responsible external organizations. Major activities include but are not limited to: screening, which is the process whereby a determination is made concerning the necessity for further professional assessment and services; assessment (including family members or significant others), which is the explication of a patient's problem or problems and the initial determination of a course of action for resolving the problem or problems; and the provision of problem-focused services (such as dealing with psychosocial problems as they relate to a patient's health and/or hospitalization, and arranging for post-discharge care of patients), which are directed toward the resolution of identified problems.

(ii) Description. This cost center contains the direct expenses incurred in providing social services to patients. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(5) 8360 HOUSING

8361 Employee Housing

8362 Nonpaid Worker Housing

8363 Student Housing

(i) Function. Housing is the provision of living quarters to hospital employees and nonpaid workers; and maintenance of residences for students, including interns and residents, participating in education programs carried on by the hospital.

(ii) Description. This cost center shall contain the direct expenses incurred in providing living quarters for hospital employees, nonpaid workers, and students involved in educational programs carried on by the hospital. Expenses of on-call rooms shall be included in this cost center only if they are not directly identifiable to another cost center. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: average number of persons housed. Record the number of days each person is in the facility. Accumulate the monthly totals and divide by 12 to obtain the average number of persons housed.

(iv) Data source. The average number of persons housed shall be determined from the record of employees housed maintained in the Housing cost center.

(6) 8410 PLANT OPERATIONS AND MAINTENANCE

8410 Plant Operations

8412 Plant Maintenance

8413 Grounds

(i) Function. Plant Operations and Maintenance includes the maintenance and service of utility systems such as heat, light, water, air conditioning and air treatment; the maintenance and repair of buildings, parking facilities, and equipment; painting; elevator maintenance; vehicle maintenance; performance of minor renovation of buildings and equipment; and maintenance of grounds of the institution, such as landscaped and paved areas, streets on the property, sidewalks, fenced areas and fencing, external recreation areas, and parking facilities. Additional activities include, but are not restricted to, the following:

Trash disposal; boiler operation and maintenance; service and maintenance of water treatment facilities, drainage systems and utility transmission systems. Including all maintenance performed under contract; technical assistance on equipment purchases and installation; coordinating construction; establishing priorities for repairs and utility projects.

(ii) Description. This cost center shall contain the direct expenses incurred in the operation and maintenance of the hospital plant and equipment except the maintenance, repair and renovation of renal dialysis equipment used for Home Dialysis for which the hospital has been 100 percent reimbursed by Medicare. Such costs must be reported in the Home Program Dialysis Equipment--100 Percent cost center (account 6810). Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, utilities (except telephone and telegraph), other direct expenses and transfers. (iii) Standard Unit of Measure: number of gross square feet. Gross square feet is defined as the total interior floor area of the hospital facility, including common areas (hallways, stairways, elevators, lobbies, closets, etc.), measured to the center of interior walls.

(iv) Data source. The number of gross square feet shall be taken from current blueprints of the hospital facility, or from actual measurement in blueprints are not available.

(v) Expiration date. This cost center will be replaced by account 8400 (Plant Maintenance) and account 8410 (Plant Operation) effective with cost reporting periods beginning in 1982.

(7) 8400 PLANT MAINTENANCE

(i) Description. Maintenance and repair of buildings, grounds and fixed equipment; painting; vehicle operation (except operation of ambulances) and maintenance; care of grounds; and performance of minor renovations of buildings, fixed equipment, grounds, drainage systems and utility transmission systems, including all such maintenance performed under contract. Also included are expenses associated with technical assistance on equipment purchases and installations; coordinating construction; establishing priorities for repairs and utility projects; and operation, service and repair of parking lots. Exclude the costs of maintenance, repair and renovation of renal dialysis equipment used for Home Dialysis for which the hospital has been 100 percent reimbursed by Medicare. Such costs must be reported in the Home Program Dialysis Equipment--100 Percent cost center (account 6810). Examples of Job titles include chief engineer, stationary engineer, carpenter, plumber, electrician, painter, dispatcher, driver, groundskeeper, plasterer, parking lot attendant, guard, mechanic, electromedical equipment repairman, clerk and secretary.

(ii) Standard Unit of Measure: gross square feet. Gross square feet is defined as the total interior floor area of the hospital facility, including common areas.

(iii) Data source. Square feet shall be determined from the blueprints of the hospital facility, or actual measurement in blueprints are not available.

(iv) Effective date. Cost reporting periods beginning 1982 and thereafter.

(8) 8410 PLANT OPERATION

(i) Description. Maintenance and service of utilities, such as heat, light, water, air conditioning and air treatment; trash disposal; hourly operation and maintenance; service and maintenance of water treatment facilities and drainage systems. Examples of job titles include: director of plant operations, foreman, elevator operator, tool crib operator, incinerator and mechanic. This cost center also includes the direct expense of utilities such as: electricity, natural gas, liquid propane or butane gas, oil coal, purchased steam and hot water and water and sewage. Telephone and telegraph service are not considered utilities but are included in the Hospital Administration cost center (account 8610).

(ii) Standard Unit of Measure: gross square feet. Gross square feet is defined as the total interior floor area of the hospital facility, including common areas.

(iii) Data source. Square feet shall be determined from the blueprints of the hospital facility, or actual measurement if blueprints are not available.

(iv) Effective date. Cost reporting periods beginning in 1982 and thereafter.

(9) 8430 SECURITY (i) Function. The Security cost center maintains the safety and well-being of hospital patients, personnel and visitors, and protects the hospital's facilities.

(ii) Description. This cost center shall include the direct expenses incurred maintaining the safety and well-being of hospital patients, employees, visitors, and protection of the hospital facilities. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(10) 8440 PARKING (i) Function. Parking includes the provision of parking facilities to patients, physicians, employees and visitors.

(ii) Description. This cost center shall contain the direct expenses of parking facilities owned and/or operated by the hospital. Included as direct expenses are: salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.

(iii) Standard Unit of Measure: none required; not applicable.

(11) 8450 HOUSEKEEPING (i) Function. This cost center is responsible for the care and cleaning of the interior physical plant, including

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Section 444.22 - Non-operating revenue and expenses description

444.22 Non-operating revenue and expenses description. (3290) (a) Non-operating revenue and expenses include those revenues and expenses not directly related to patient care, related patient services, or the sale of related goods. The following accounts are required to be reported.

(b) 9010 GAINS OR LOSSES ON SALE OF HOSPITAL PROPERTY. This account is credited for gains and debited for losses arising as a result of the disposal of hospital property.

(c) 9020 UNRESTRICTED CONTRIBUTIONS. All contributions, donations, legacies and bequests, that are made to the hospital without restrictions by the donors, must be credited to this account. When a hospital receives contributions in significant amounts, such contributions should be clearly described and fully disclosed in the income statement.

(d) 9030 DONATED SERVICES. Many hospitals receive donated services of individuals. Fair value of donated services must be recorded when there is the equivalent of an employer-employee relationship and an objective basis for valuing such services. The value of services donated by organizations may be evidenced by a contractual relationship which may provide the basis for valuation.

Donated services are most likely to be recorded in a hospital operated by a religious group. If members of the religious group are not paid (or are paid less than the fair value of the services rendered), the lay-equivalent value of their services (or the difference between lay-equivalent value of services rendered and compensation paid) must be recorded as an expense in the cost center in which the service was rendered, with the credit to this account.

(e) 9040 INCOME, GAINS AND LOSSES FROM UNRESTRICTED INVESTMENTS. Income, and gains and losses from investments of unrestricted funds must be recorded in this account.

(f) 9050 UNRESTRICTED INCOME FROM ENDOWMENT FUNDS. This account is credited with the unrestricted revenue and net realized gains on investments of endowment funds.

(g) 9060 UNRESTRICTED INCOME FROM OTHER RESTRICTED FUNDS. This account is credited with the revenue and net realized gains on investments of restricted funds (other than endowment funds) if the income is available for unrestricted purposes.

(h) 9070 TERM ENDOWMENT FUNDS BECOMING UNRESTRICTED. When restricted endowment funds become available for unrestricted purposes, they must be reported in this account.

(i) 9080 TRANSFERS FROM RESTRICTED FUNDS FOR NON-OPERATING EXPENSE. This account reflects the amounts of transfers from restricted funds to match non-operating expenses in the current period for restricted fund activities.

(j) 9110 DOCTORS' PRIVATE OFFICE RENTAL REVENUE. This account is credited with the revenue earned from rental of office space and equipment to physicians and other medical professionals for use in their private practice.

(k) 9120 OFFICE AND OTHER RENTAL REVENUE. This account is credited with rentals received from other than doctors, other medical professionals and other non-retail rental activities for office space located in the hospital and for other rental of property, plant and equipment not used in hospital operations.

(l) 9130 RETAIL OPERATIONS REVENUE. This account must be credited with revenue earned from other retail operations such as gift shop, barber shop, beauty shop, drug store or newsstand located in space owned by the hospital.

(m) 9150 OTHER NON-OPERATING REVENUE. This account is credited with non-operating revenue not specifically required to be included in the above accounts, including unrestricted tax revenue and funds appropriated by governmental entities.

(n) 9210 DOCTORS' PRIVATE OFFICE RENTAL EXPENSES. This account contains the expenses incurred in connection with the rental of office space and equipment to physicians, and other medical professionals for use in their private practice.

(o) 9220 OFFICE AND OTHER RENTAL EXPENSE. This cost center contains the expenses incurred in connection with the rental to other than physicians, other medical professionals and non-retail rental activities.

(p) 9230 RETAIL OPERATIONS EXPENSE. This cost center contains the expenses incurred in connection with retail operations such as gift shop, barber shop, drug store, beauty shop or newsstand.

(q) 9240 MAINTENANCE OF NON-PAID WORKERS. (1) This cost center is used to record the direct costs and accumulate the indirect costs of furnishing to nonpaid workers (as defined and described in 42 CFR 405-424) such fringe benefits, perquisites, maintenance and other items and services that are not furnished to paid employees occupying similar positions, and in situations where comparable fringe benefits, perquisites, maintenance and other items and services are furnished to paid employees occupying similar positions, and if the total cost applicable to nonpaid workers (imputed value of services, fringe benefits, perquisites, maintenance and other items and services) exceeds the total cost (salaries, fringe benefits, etc.) incurred on behalf of comparable paid employees, such excess is included in this cost center. (2) Effective date for this cost center: cost reporting periods beginning in 1981.

(r) 9250 OTHER NON-OPERATING EXPENSES. This cost center contains non-operating expenses not specifically required to be included in the above accounts.

(s) 9410 PROVISION FOR INCOME TAXES

9411 Federal-Current

9412 Federal-Deferred

9413 State-Current

9414 State-Deferred

9415 Local-Current

9416 Local Deferred

These cost centers contain income tax expense and related deferred taxes.

(t) 9500 EXTRAORDINARY ITEMS. Cost centers (accounts 9500-9599) should be used to segregate extraordinary items from the results of ordinary operations and to disclose the nature thereof. Each hospital is to follow "Generally Accepted Accounting Principles" (GAAP) to determine when items are to be considered extraordinary.
 

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NATURAL CLASSIFICATION OF EXPENSE

Section 444.23 - Natural classification of expense

NATURAL CLASSIFICATION OF EXPENSE

444.23 Natural classification of expense. (3300) (a) General.

(1) The fifth and sixth digits of the hospital's expense accounts are used to record the Natural Classification of Expense. There are nine major account classification categories with subaccounts. The required level of reporting for the natural classification of expense is the major natural account classification categories ending in zero, except for salaries and wages. Salaries and wages subaccounts must be reported. While the reporting of the remaining subaccounts is not required, they are recommended to achieve greater uniformity in accounting and reporting.

(2) The major categories are as follows:

.00-.19 Salaries and Wages

.20-.29 Employee Benefits

.30-.39 Professional Fees

.40-.49 Medical and Surgical Supplies

.50-.59 Non-Medical and Non-Surgical Supplies

.60-.69 Utilities

.70-.79 Purchased Services

.80-.89 Other Direct Expense

.90-.97 Depreciation/Rent/Transfers

(3) A hospital desiring a more detailed identification of expenses may at its option use an additional digit or digits to obtain the desired detail.

(b) .00, .10 Salaries and Wages. (3310) (1) Salaries and wages and full-time equivalent (FTE) employees must be reported by 12 sub-classification of salaries and wages for both paid employees and nonpaid workers. The hospital is required to report salaries and wages and paid FTE's for all personnel whose compensation is included on the payroll, including exempt personnel, and for nonpaid workers. FTE's are computed by dividing total paid hours by 2080. Paid hours include both worked and nonworked hours for which employees are compensated.

(2) Overtime hours are hours for which an overtime pay rate is used. The actual overtime hours are not treated differently from regular worked hours; it is the rate that changes.

(3) On-call and/or standby pay is compensation to an employee for being available to work. During that period when the employee is on call or on standby, he might or might not actually perform work. The Fair Labor Standards Act differentiates between restricted and unrestricted on-call situations. All restricted on-call hours are compensable and contribute to the total hours used for determining overtime pay. Unrestricted on-call hours do not contribute to total hours, but unrestricted on-call compensation does contribute to the salary base used for calculating overtime premiums only. Thus all restricted on-call hours must be accounted for, but only those hours worked need be accounted for when employees are on unrestricted on-call duty.

(4) In those instances where the hospital has a policy to pay for a minimum number of hours whenever an employee is called back to work, and the employee works less than the minimum number of hours, the worked time recorded will include only the number of hours actually worked. For example, a four-hour minimum is guaranteed; the employee works two hours and returns home. The hospital will record only two hours as worked time.

(5) Salaries and wages are defined as (i) all remuneration, payable in cash, for services performed by an employee for the hospital, and (ii) the fair market value of donated services when there is the equivalent of an employer-employee relationship. The value of donated services may be evidenced by a contractual relationship which may provide the basis for valuation. If persons donating the services are not paid (or are paid less than fair market value of their services), the lay-equivalent salaries (or the difference between lay-equivalent salaries and salaries paid) must be reported as expense with the offsetting amount reported as nonoperating revenue in account 9030, Donated Services. Do not include services rendered by persons such as candy stripers unless the hospital would actually hire someone to perform such services. Reimbursement of independent contractors such as private duty nurses must be excluded.

(6) The classifications of salaries and wages are defined below. See Part 445 of this Article for a list of job titles and the natural classification to which assigned.

(i) .01 Management and Supervision. Employees included in this classification are primarily involved in the direction, supervision and coordination of hospital activities. Usually included here are job titles such as Administrator, Manager, Department Head, Supervisor, Director and Foreman.

(ii) .02 Technician and Specialist. Employees included in this classification usually perform activities of a creative or complex nature. Includes such job titles as Coordinator, Technologist, Technician, Therapist, instructor and Accountant. These employees are often licensed or registered. Some of these positions are exempt from Federal wage and hour laws as administrative or professional. Lead positions of Chief, Head, etc, must be classified as Management and Supervision (.01) if they provide direct supervision of five or more other employees. (iii) .03 Registered Nurses. This classification includes only Registered Nurses employed in the performance of direct nursing care to patients. Registered Nurses performing supervisory functions must be classified as Management and Supervision (.01). Those functioning as instructors and coordinators must be classified as Technical (.02). Lead nurses must be classified as Management and Supervision (.01) if they provide direct supervision of five or more other employees.

(iv) .04 Licensed Vocational (Practical) Nurses. This classification includes Licensed Vocational (Practical) Nurses employed in the performance of direct nursing care to patients. Those Licensed Vocational (Practical) Nurses not providing direct patient care should be classified as Technical (.02).

(v) .05 Aides, Orderlies and Attendants. Included in this classification are non-technical personnel employed for providing direct nursing care to patients. Included are job titles such as aide, orderly and nurse assistant. These employees are subject to Federal wage and hour laws.

(vi) .06 Physicians. Include in this classification all salaries paid to physicians. This employee must possess a Doctor of Medicine or Doctor of Osteopathy degree and be licensed to practice medicine. Include physicians as Management and Supervision (.01) if they provide direct supervision to five or more other employees.

(vii) .07 Dentists. Include in this classification all salaries paid to dentists. This employee must possess a doctoral degree in dentistry and be licensed to practice dentistry. Include dentists as Management and Supervision (.01) if they provide direct supervision to five or more other employees.

(viii) .08 Resident and Fellow. Employees included in this classification are employed for consulting, diagnosing, prescribing and providing treatment for patients. Also included would be stipends paid to residents, which would be reported only in the Postgraduate Medical Education--Approved Teaching Program (account 8240) or Postgraduate Medical Education--Non-Approved Teaching Program (account 8250).

(ix) .09 Non-Physician Medical Practitioners. Employees included in this classification are employed to consult, diagnose, prescribe and treat patients under the direction of, or in consultation and collaboration with a physician. Includes such job titles as Nurse Practitioner, Physician's Assistant, licensed midwife or Medic.

(x) .11 Environment, Hotel, and Food Service Employees. This classification includes personnel employed in providing basic services related to food and accommodations. They perform routine work of a non-technical nature and are subject to Federal wage and hour laws. Examples of job titles are maintenance man, housekeeping aide, cooks' helper, flatwork finisher, guard, food service worker, wall washer, and wash person.

(xi) .12 Clerical and Other Administrative Employees. Included in this classification are non-technical personnel employed in the performance of recordkeeping, communication and other administrative functions. Examples of job titles are accounting clerk, admitting clerk, messenger, keypunch operator, secretary, telephone operator, clerk-typist, cashier and receptionist. These employees are subject to Federal wage and hour laws.
(xii) .19 Other Employee Classifications. This classification includes personnel not included in the job classes described above.

(c) Employee Benefits. (3320) (1) The following employee benefits are to be included as direct costs of all cost centers whose employees received such benefits:

(i) .21 FICA.

(ii) .22 SUI and FUI. These classifications are charged with the employer's portion of the Social Security tax, State Unemployment Insurance, and Federal Unemployment Insurance.

(iii) .23 Group Health Insurance

(iv) .24 Group Life Insurance

(v) .25 Pension and Retirement

(vi) .26 Workers' Compensation Insurance

(vii) .27 Union Health and Welfare

(viii) .28 Other Payroll-Related Employee Benefits

(ix) .29 Employee Benefits (Non-Payroll-Related)

(2) Classifications .23-.28 are to be charged with the cost of employee benefits specified by the respective account titles. Classification .29, non-payroll-related employee benefits, are to be reported in the Employee Benefits--Non-Payroll-Related cost center (account 8830).

(d) Professional Fees. (3330) (1) Fees and other amounts (almost exclusively labor-related expense) paid for professional services of people who are not on the hospital payroll include the following classifications: physicians, therapists and other medical non-physician personnel (such as registry nurses), consulting and management fees, legal fees, audit fees, accounting fees and other professional fees. Management Fees paid to related organizations are to be reported as Purchased Services in the appropriate functional cost centers. (2) .31 Medical--Physicians. Include in this classification all fees paid to physicians. See section 1680 (Physician Remuneration).

(3) .32 Medical--Therapists and Other Non-Physicians. This classification is charged with amounts paid to medical personnel, other than physicians, not on the payroll, such as registered physical therapists and registry nurses.

(4) .33 Consulting and Management Fees. This classification is charged with amounts paid to consultants and management firms when such consultants and firms are not a related organization. Amounts paid to related organizations are charged to natural classification "Management and Contracted Services" (.76).

(5) .34 Legal Fees.

.35 Audit Fees.

.39 Other Fees.

These classifications are to be charged with the amount of legal fees, audit fees, and other fees not included elsewhere.

(e) .40 MEDICAL AND SURGICAL SUPPLIES. (3340) (1) The following classifications are used to record the costs of the various types of medical and surgical supplies used by a hospital. The fair market value of donated supplies is charged to these classifications if the commodity otherwise would be purchased by the hospital. An offsetting credit is made to "Donated Commodities" (account 5760).

(2) .41 Prostheses. The cost of replacements for parts of the body, and substitutes or aids to permanently impaired functions of the body, is charged to this classification. This includes such items as artificial limbs and eyes, dentures, bone plates, permanent braces, eyeglasses, implanted pacemakers, corrective footwear, etc. Also included are components used in the assembling and fitting of such items.

(3) .42 Surgical Supplies--General. The cost of sutures, surgical needles, surgical packs and sheets and all other surgical supplies not described elsewhere is charged to this classification.

(4) .43 Anesthetic Materials. This classification should be charged with the cost of gaseous and volatile agents used in inhalation anesthesia such as cyclopropane, fluothane, halothane, nitrous oxide, ether and chloroform.

(5) .44 Oxygen and Other Medical Gases. The cost of gases, other than anesthesia gases, used in treatment of patients, such as oxygen and carbon dioxide mixtures, should be charged to this classification. Oxygen used to drive equipment such as fog generators and atomizers should be also charged here.

(6) .45 I.V.Solutions

.46 Pharmaceuticals

.47 Radioactive Materials

.48 Radiology Films

.49 Other Medical Care Materials and Supplies

These classifications (.45-.49) should be charged with the cost of I.V. solutions, pharmaceutical supplies, radioactive materials, radiology films, and other medical care materials and supplies, respectively.

(f) .50 NON-MEDICAL AND NON-SURGICAL SUPPLIES (3350)

(1) .51 Food--Meats, Fish and Poultry

.52 Food--Other

Food purchased for dietary, kitchen or the cafeteria should be charged to these classifications.

(2) .53 Tableware and Kitchen Utensils

.54 Linen and Bedding

.55 Cleaning Supplies

.56 Office and Administrative Supplies

.57 Employee Wearing Apparel

These classifications should be charged with the cost of tableware and kitchen utensils, linen and bedding, cleaning supplies, office and administrative supplies, and employee wearing apparel.

(3) .58 Instruments and Minor Equipment. The cost of minor equipment, as previously defined in section 1385, is charged to this classification.

(4) .59 Other Non-Medical and Non-Surgical Supplies. This classification should be charged with the cost of non-medical and non-surgical supplies not included elsewhere. Included here is the cost of miscellaneous supplies used for the personal care of patients.

(g) .60 UTILITIES (3360)

.61 Electricity

.62 Fuel

.63 Water

.64 Disposal Service

.65 Telephone/Telegraph

.66 Purchased Steam

.69 Utilities-Other

All utilities except Telephone/Telegraph are to be charged to Plant Operations and Maintenance (account 8410).

(h) .70 PURCHASED SERVICES (3370)

.71 Medical

.72 Maintenance and Repairs

.73 Medical School Contracts

.74 Laundry and Linen

.75 Data Processing

.76 Management and Contracted Services

.77 Collection Agency

.78 Transcription Services

.79 Other Purchased Services

These classifications should be used to record the costs of purchased services.

For instance, if the laboratory function is purchased outside the hospital, the expense would be charged to classification .71--Medical in Laboratory Services--Clinical (account 7210) or Laboratory Services--Pathological (account 7230), as appropriate. Medical School Contracts natural classification would only appear in the Education cost centers. The Management and Contracted Services Account (.76) is to include only fees paid to related organizations. Include expenses incurred for temporary help services in classification .79, Other Purchased Services. (i) .80 OTHER DIRECT EXPENSES (3380)

.81 Insurance

.82 Interest

.83 Licenses and Taxes (Other than on Income)

.84 Dues, Books and Subscriptions

.85 Outside Training Sessions (including Travel)

.86 Travel--Other

.87 Postage

.88 Printing and Duplicating

.89 Other Expenses

Other direct expenses such as those indicated above are included in these classifications.

(j) .90 DEPRECIATION/RENT (3390)

.91 Depreciation and Amortization--Buildings and Building Improvements

.92 Depreciation--Fixed Equipment

.93 Depreciation Movable Equipment

.94 Depreciation and Amortization--Land Improvements and Other

.95 Lease/Rentals--Buildings, Improvements and Fixed Equipment

.96 Lease/Rentals--Movable Equipment

.97 Lease/Rentals--Other

(k) Interdepartmental transfers of direct expense. In order to maintain the integrity of the Natural Classifications, all transfers of direct expenses to cost centers must be debited and credited to the appropriate Natural Classification within the cost center expense accounts. The effect of this entry is the same as if the initial charge was incorrect and the correct cost center is then charged.

Effective Date: 
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