Article 8 - New York State Annual Hospital Report

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Part 440 - Applicability and Purpose

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Section 2803-b

Section 440.1 - Applicability

Section 440.1 Applicability. (a) This Article is applicable to all medical facilities covered by the term general hospital as defined in article 28, section 2801, subdivision 11 of the Public Health Law.

(b) The term general hospital means a hospital engaged in providing medical or medical and surgical services primarily to inpatients, by or under the supervision of a physician, on a 24-hour basis, with provisions for admission or treatment of persons in need of emergency care, and with an organized medical staff and nursing service, including facilities providing services relating to particular diseases, injuries, conditions or deformities. The term general hospital shall not include a residential health care facility, public health center, diagnostic center, treatment center, outpatient lodge, dispensary and laboratory or central service facility serving more than one institution.
 

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Section 440.2 - Purpose

440.2 Purpose. (a) The purpose of this Article is to provide a common standard of measure and communication through the use of uniform:

(1) reporting principles:

(2) classification system which identifies cost by functional cost center by the nature of costs incurred, and revenues by revenue center by patient classification: and

(3) statistical and service data definitions.

(b) This Article presents the definitions, principles, statistics, and listing of accounts to be employed for reporting and reimbursement purposes. This Article has been developed to provide the data base necessary to support reimbursement regulations.
 

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Part 441 - Definitions

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Section 2803-b

Section 441.1 - General

Section 441.1 General. For the purposes of this Article, the following terms shall have the following meanings.
 

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Section 441.2 - Abandonment

441.2 Abandonment. The complete retirement of a fixed asset from service, following salvage or other reclaiming of removable parts.

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Section 441.3 - Accelerated payments

441.3 Accelerated payments. Amounts received where delays in payments by an intermediary for covered services rendered to beneficiaries have caused financial difficulties for the hospital, or where a hospital has incurred a temporary delay in its bill processing beyond the provider's normal billing cycle.
 

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Section 441.4 - Account

441.4 Account. A formal record of a particular type of transaction expressed in money and kept in a ledger.
 

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Section 441.5 - Accountability

441.5 Accountability. The obligation of an employee, agent or other person to supply a satisfactory report, often periodic, of action or of failure to act following delegated authority/responsibility.
 

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Section 441.6 - Accounting control

441.6 Accounting control. The administrative procedures employed in maintaining the accuracy and propriety of transactions and the bookkeeping record thereof.
 

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Section 441.7 - Accounting policy

441.7 Accounting policy. The general principles and procedures under which the accounts of an organization are maintained and reported; any one such principle or procedure.
 

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Section 441.8 - Accrual

441.8 Accrual. (a) The recognition of events and conditions as they occur, rather than in the period of their receipt, or payment.

(b) The partial recognition of an item of revenue or expense and its related assets or liability resulting from the lack of coincidence of the reporting period and the contractual or benefit period.

(c) An amount accrued.
 

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Section 441.9 - Accrual reporting

441.9 Accrual reporting. The recognizing and reporting of the effects of transactions and other events on the assets and liabilities of the hospital entity in the time period to which they relate, rather than only when cash is received or paid.
 

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Section 441.10 - Accrue

441.10 Accrue. To give effect to an accrual; to record revenue or expense in the reporting period to which it relates, notwithstanding that the required receipt or outlay may take place, in whole or in part, in a preceding or following accounting period.
 

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Section 441.11 - Accrued depreciation

441.11 Accrued depreciation. The total depreciation incurred by an asset or asset group, based on customary or fairly determined rates or estimates of useful life, now generally referred to as accumulated depreciation.
 

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Section 441.12 - Accrued expense

441.12 Accrued expense. See accrued liability.
 

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Section 441.13 - Accrued liability

441.13 Accrued liability. An amount of interest, wages, or other expense recognized or incurred on and before a given date but not paid; sometimes referred to as accrued expense.
 

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Section 441.14 - Accrued revenue

441.14 Accrued revenue. Revenue earned, but neither received nor past due.
 

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Section 441.15 - Accumulated depreciation

441.15 Accumulated depreciation. The fixed-asset valuation account resulting from depreciation provisions; also known as reserve for depreciation, accrued depreciation, and allowance(s) for depreciation.

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Section 441.16 - Active medical staff

441.16 Active medical staff. Hospital-based and nonhospital-based physicians, other than interns and residents who are voting members of and can hold office in the medical staff organization of the hospital.

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Section 441.17 - Actuarial basis

441.17 Actuarial basis. A basis compatible with principles followed by actuaries: said of computations involving compound interest, retirement and mortality estimates, and the like.
 

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Section 441.18 - Acute care

441.18 Acute care. Inpatient general routine care 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 an institution.

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Section 441.19 - Addition

441.19 Addition. An addition is something which does not merely replace a thing previously owned. This includes enlargements and extensions of existing facilities.
 

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Section 441.20 - Additional (paid-in) capital

441.20 Additional (paid-in) capital. Contributions of corporate stockholders credited to accounts other than capital stock; sources: an excess over par or stated value received from the sale or exchange of capital stock, an excess of par or stated value of capital stock reacquired over the amount paid therefor, or an excess from recapitalization; often displayed on the balance sheet as a separate item or in combination with par or stated value and designated paid-in capital; known also as paid-in surplus.
 

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Section 441.21 - Admission

441.21 Admission. The formal acceptance by an institution of a patient who is to be provided with room, board, continuous nursing service, and other institutional services while lodged in the institution.
 

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Section 441.22 - Adult beds

441.22 Adult beds. Those beds assigned for regular use by inpatients who are 14 years of age or over, and which are maintained in areas allotted for adult or adolescent lodging, even though in some instances utilized by children.
 

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Section 441.23 - Advance

441.23 Advance. (a) Payment of cash or the transfer of goods for which an accounting must be rendered by the recipient at some later date.

(b) A payment of a contract before its completion.

(c) The payment of wages, salaries, or commissions before they have been earned.

(d) Deferred income or expense.
 

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Section 441.24 - Affiliate

441.24 Affiliate. A corporation or other organization related to another by owning or being owned, by common management or by a long-term lease of its properties or other control device.
 

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Section 441.25 - Age

441.25 Age. The number of years or other time periods an asset or asset group has remained in service at a given date.
 

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Section 441.26 - AICPA

441.26 AICPA. American Institute of Certified Public Accountants.
 

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Section 441.27 - Alcohol and drug unit

441.27 Alcohol and drug unit. A unit for the care of alcohol and/or drug rehabilitation inpatients. The hospital must also employ specially trained personnel to staff this unit, and at least one psychiatrist must be on the medical staff.

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Section 441.28 - Ambulance calls

441.28 Ambulance calls. The number of trips made in response to a request for assistance.
 

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Section 441.29 - Ambulatory care

441.29 Ambulatory care. Health services rendered to persons who are not confined overnight in a health care institution. Ambulatory care services are often referred to as outpatient services.
 

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Section 441.30 - Ambulatory services

441.30 Ambulatory services. The essential characteristic of ambulatory services is that the patients come to or are brought to a facility of the hospital for a purpose other than admission as an inpatient. Ambulatory services include emergency services, clinical services, ambulance services and home health services, but exclude ancillary services.
 

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Section 441.31 - Amortization

441.31 Amortization. (a) The gradual extinguishment of any amount over a period of time: as, the retirement of a debt by serial payments to the creditor or into a sinking fund; the periodic writedown of an insurance premium or a bond premium.

(b) A reduction of the book value of a fixed asset: a generic term for the depreciation, depletion, writedown or writeoff of a limited-life asset.
 

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Section 441.32 - Ancillary services

441.32 Ancillary services. Diagnostic or therapeutic services performed by specific facility departments as distinguished from general or routine patient care such as room and board. Ancillary services generally are those special services for which charges are customarily made in addition to routine charges and include such services as laboratory, radiology, surgical services, etc.
 

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Section 441.33 - Asset

441.33 Asset. Any owned physical object (tangible) or right (intangible) having economic value to its owner: an item or source of wealth expressed, for accounting purposes, in terms of its cost, depreciated cost, or fair market value at date of donation.
 

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Section 441.34 - Audit

441.34 Audit. (a) The examination of contracts, orders and other original documents for the purpose of substantiating individual transactions before their settlement.

(b) Any systematic investigation or appraisal of procedures or operations for the purpose of determining conformity with prescribed criteria; the work performed by an internal auditor.

(c) Auditing. An exploratory, critical review by a public accountant of the underlying internal controls and accounting records of a business enterprise or other economic unit, precedent to the expression by him of an opinion of the propriety ("fairness") of its financial statements.
 

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Section 441.35 - Available beds

441.35 Available beds. Health facility beds which are maintained and staffed for the provision of patient care.
 

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Section 441.36 - Average daily inpatient census

441.36 Average daily inpatient census. Average number of inpatients (based on the daily inpatient census) present each day for a given period of time.
 

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Section 441.37 - Average length of stay

441.37 Average length of stay. The average number of days of service rendered to each inpatient discharged during a given period.
 

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Section 441.38 - Average life

441.38 Average life. The arithmetic mean of the estimated useful-life expectancies of a group of assets subject to depreciation.
 

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Section 441.39 - Bad debt

441.39 Bad debt. An uncollectible receivable.
 

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Section 441.40 - Balance

441.40 Balance. (a) The difference between the total debits and the total credits of an account, or the total of an account containing only debits or credits.

(b) The equality of the total debit balances and the total credit balances of the accounts in a ledger.

(c) Agreement of the total of the account balances in a subsidiary ledger with its general-ledger control.
 

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Section 441.41 - Balance sheet

441.41 Balance sheet. A statement of financial position of any economic unit, or component thereof, reporting as at a given moment of time its assets (at cost, depreciated cost, or other indicated value), its liabilities, and its ownership equities recorded under an accounting system.
 

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Section 441.42 - Bassinets

441.42 Bassinets. Those beds assigned for regular use by infants newly born in the hospital and which are maintained in areas allotted for newborn infant lodging.
 

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Section 441.43 - Bed complement (beds available)

441.43 Bed complement (beds available). The total number of accommodations which are available (those set up and staffed for use). This figure should exclude the newborn nursery bassinets, beds in rooms intended for induction, recovery, labor, emergency, diagnostic and treatment purposes, and beds in such nonadaptable areas as corridors.
 

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Section 441.44 - Betterment

441.44 Betterment. An expenditure having the effect of extending the useful life of an existing fixed asset, increasing its normal rate of output, lowering its operating cost, increasing rather than merely maintaining efficiency or otherwise adding to the worth of benefits it can yield.
 

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Section 441.45 - Blood bank transfusions

441.45 Blood bank transfusions. The number of whole blood and packed red cell units prepared for transfusion. A unit is considered to be 500 cc.
 

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Section 441.46 - Board-designated assets

441.46 Board-designated assets. Unrestricted assets set aside by the governing board for specific purposes or projects.
 

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Section 441.47 - Boarder baby

441.47 Boarder baby. (a) A baby receiving lodging in the institution and who is not an institution patient.

(b) A newborn infant whose mother is discharged but the newborn does not occupy a patient bed but is retained in the nursery.
 

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Section 441.48 - Bond

441.48 Bond. (a) A certificate of indebtedness, in writing and often under seal.

(b) An obligation in writing, binding one or more parties as surety for another.
 

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Section 441.49 - Bond discount

441.49 Bond discount. The excess of the face amount of a bond or class of bonds over the net amount yielded from its sale. On the books and balance sheet of the issuer it appears as a deferred charge.
 

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Section 441.50 - Bond premium

441.50 Bond premium. The net amount yielded by the sale of a bond or class of bonds in excess of its face value. On the books and balance sheet of the issuer it appears as a deferred credit.
 

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Section 441.51 - Book inventory

441.51 Book inventory. (a) An inventory which is not the result of actual stocktaking but of adding the units and the cost of incoming goods to previous inventory figures and deducting the units and cost of outgoing goods.

(b) The balances of materials or products on hand in quantities, dollars, or both, appearing in perpetual inventory accounts.
 

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Section 441.52 - Book of original entry

441.52 Book of original entry. A record book, recognized by law or custom, in which transactions are successively recorded, and which is the source of postings to ledgers; a journal. Books of original entry include general and special journals, such as cashbooks and registers of sales and purchases.
 

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Section 441.53 - Book value

441.53 Book value. (a) The net amount at which an asset or asset group appears on the books of account, as distinguished from its market value or some intrinsic value.

(b) The face amount of a liability less any unamortized discount and expense.

(c) As applied to capital stock:

(1) the book value of the net assets;

(2) in a corporation, the book value of the net assets, divided by the number of outstanding shares of capital stock.
 

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Section 441.54 - Burn center

441.54 Burn center. A burn unit (see section 444.18(b)(5) of this Article for the definition of a burn care unit) with an emphasis on research and teaching, where the intensive care environment serves as a classroom for teaching the complexities of burn care and a laboratory for research.
 

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Section 441.55 - Capital asset

441.55 Capital asset. (a) An asset intended for continued use or possession.

(b) Common subclassifications are:

(1) land, buildings and equipment, leaseholds (fixed assets);

(2) goodwill, patents, trademarks, franchises (intangibles);

(3) investments in affiliated companies.
 

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Section 441.56 - Capital expenditure

441.56 Capital expenditure. An expenditure intended to benefit future periods, in contrast to a revenue expenditure, which benefits a current period; an addition to a capital asset. The term is generally restricted to expenditures that add fixed-asset units or that have the effect of increasing the capacity, efficiency, life span, or economy of operation of an existing fixed asset.
 

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Section 441.57 - Capital lease

441.57 Capital lease. (a) A lease which meets one of the following four criteria:

(1) The present value of the minimum lease payments is 90 percent or more of the fair value of the property to the lessor.

(2) The lease term is 75 percent or more of the leased property's estimated economic life.

(3) The lease contains a bargain (less than fair value) purchase option.

(4) Ownership is transferred to the lessee by the end of the lease term.

(b) See FASB Statement No. 13 for further details.
 

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Section 441.58 - Capitalize

441.58 Capitalize. (a) To record and carry forward into one or more future periods any expenditure, the benefits or proceeds from which will then be realized.

(b) To add to a fixed asset account the cost of plant additions, improvements and expenditures having the effect of increasing the efficiency or yield of a capital asset or making possible future savings in cost from its use.

(c) To transfer surplus to a capital-stock account, as the result of the issue of a stock dividend, a recapitalization, or, under the laws of some states, resolution of the board of directors.

(d) To discount or calculate the present worth of the projected future earnings of an asset or business.
 

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Section 441.59 - Certificate of deposit

441.59 Certificate of deposit. (a) A formal instrument, frequently negotiable or transferable, issued by a bank as evidence of indebtedness and arising from a deposit of cash subject to withdrawal under the specific terms of the instrument: (1) demand certificates, payable upon presentation, seldom bearing interest; (2) time certificates, payable at a fixed or determinable future date, usually bearing interest at a specific rate.

(b) A formal certificate, usually printed or engraved, ordinarily negotiable or transferable, and issued by a depository or agent against the deposit of bonds or stock of a corporation under the terms of a reorganization plan or other agreement.
 

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Section 441.60 - Certified bed capacity

441.60 Certified bed capacity. The total number of beds for which the facility has approval from the Commissioner of Health to operate. This is the number of beds that appears on the operating certificate.
 

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Section 441.61 - Certified bed days available

441.61 Certified bed days available. Bed days are computed by multiplying the number of certified beds (excluding newborn) available throughout the period by the number of days in the period. If there is an increase or decrease in the number of certified beds available during the period, the number of certified beds available for each part of the cost reporting period should be multiplied by the number of days for which that number was available.
 

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Section 441.62 - Chain organization

441.62 Chain organization. A health care, or other organization consisting of a group of two or more facilities which are owned, leased or, through any other device, controlled by one business entity.
 

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Section 441.63 - Chart of accounts

441.63 Chart of accounts. A systematically arranged list of accounts applicable to a specific concern, giving account names and numbers. A chart of accounts, accompanied by descriptions of their use and of the general operation of the books of account, becomes a classification or manual of accounts.
 

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Section 441.64 - Clearing account

441.64 Clearing account. A primary account containing costs that are to be transferred to other accounts; an intermediate account to which is transferred a group of costs or revenues or a group of accounts containing costs or revenues and from which a distribution of the total is made to other accounts.
 

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Section 441.65 - Clinic outpatient

441.65 Clinic outpatient. A clinic outpatient is one who is registered with a formally organized hospital service unit known as a clinic. The clinic constitutes an organizational entity to provide diagnosis and/or treatment under the direction of a specialty or subspecialty department of the hospital pursuant to section 405.1032 of this Subchapter.
 

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Section 441.66 - Comprehensive inpatient rehabilitation service

441.66 Comprehensive inpatient rehabilitation service. A program of care providing multidisciplinary physician and restorative services; including skilled rehabilitation nursing, physical therapy, occupational therapy, activities of daily living, speech therapy, and prosthetic-orthotic services; and having a physician director whose primary activity is supervision and coordination of the various rehabilitation modalities.
 

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Section 441.67 - Consistency

441.67 Consistency. Continued uniformity, during a period or from one period to another, in methods of accounting, mainly in valuation bases and methods of accrual, as reflected in the financial statements of an accounting entity.
 

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Section 441.68 - Contract service

441.68 Contract service. Services performed in whole or in part by an outside organization on a contractual basis.
 

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Section 441.69 - Contractual adjustment

441.69 Contractual adjustment. The difference between billings at established charges and amounts received or due from third-party payors under contract agreements.
 

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Section 441.70 - Contributed capital

441.70 Contributed capital. The payments in cash or property made to a corporation by its stockholders in exchange for capital stock, in response to an assessment or the capital stock, or as a gift; paid-in capital.
 

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Section 441.71 - Contributed services

441.71 Contributed services. See donated services.
 

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Section 441.72 - Control

441.72 Control. The process by which the activities of an organization are conformed to a desired plan of action and the plan is conformed to the organization's activities.
 

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Section 441.73 - Cost

441.73 Cost. An expenditure or outlay of cash, other property, capital stock, or services, or the incurring of a liability therefor, identified with goods or services acquired or with any loss incurred, and measured by the amount of cash paid or payable or the market value of other property, capital stock, or services given in exchange or, in other situations, any commonly accepted basis of valuation. Implicit in the concept of cost is the accrual basis of accounting.
 

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Section 441.74 - Cost center

441.74 Cost center. A cost center is an accounting device for accumulating items of cost that have common characteristics. A cost center may or may not be a department within the institution. A cost center such as Depreciation and Amortization, is an example where the cost center would not be a department of the institution. A cost center may be a function within the health facility, as opposed to a department.
 

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Section 441.75 - Critical care units

441.75 Critical care units. A discrete inpatient unit within the hospital providing maximum surveillance/support of vital functions; definitive therapy for patients with acute but reversible life-threatening impairments; patient monitoring; cardiopulmonary resuscitation; other life support techniques; and a staff of health professionals who have received specialized training in the provision of these services.
 

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Section 441.76 - Critical care units (type I)

441.76 Critical care units (type I). (a) Intensive medical care.

(b) Medical director who has completed residency training in one of the major clinical specialties and has acquired advanced skills and knowledge in life support and patient monitoring techniques.

(c) The medical director devotes the majority of his time to the unit.

(d) An MD (attending or senior resident) physically present within the unit 24 hours a day.
 

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Section 441.77 - Critical care units (type II)

441.77 Critical care units (type II). (a) Intensive nursing care.

(b) Intensive nursing care 24 hours a day.

(c) Medical director who has completed residency training in one of the major clinical specialties and has acquired advanced skills and knowledge in life support and patient monitoring techniques.

(d) MD rounds within the unit at least every 24 hours, and available in-house or on call 24 hours a day.
 

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Section 441.78 - Current assets

441.78 Current assets. Unrestricted cash, or other assets held for conversion within one year into cash or other readily convertible asset, or currently useful goods or services. The five customary subdivisions of current assets are cash, temporary investments, receivables, inventory, and prepaid expenses.
 

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Section 441.79 - Current liability

441.79 Current liability. A short-term debt, regardless of its source, including any liability accrued and deferred and unearned revenue that is to be paid out of current assets or is to be transferred to income within one year. The currently maturing portion of long-term debt is thus classified unless it is to be paid from a sinking fund or other noncurrent asset source.
 

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Section 441.80 - Daily hospital services

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

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Section 441.81 - Daily inpatient census

441.81 Daily inpatient census. The number of inpatients present at the census-taking time each day, plus any inpatients who were both admitted and discharged after the census-taking time the previous day. Generally the inpatient census is taken each midnight. However, a facility may designate and consistently use any other specified hour for census-taking.
 

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Section 441.82 - Date of acquisition

441.82 Date of acquisition. The effective purchase date of an asset. Usually, this is the date title is acquired, or the burdens of ownership are assumed and the asset is in possession.
 

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Section 441.83 - Date of change in certified bed capacity--decrease

441.83 Date of change in certified bed capacity--decrease. (a) Partial decertification of beds in a unit. The date proposed in the hospital's letter of intent to decertify filed with the Department of Health and subsequently approved.

(b) Retroactive decertification of part or all of a unit. The date promulgated by the Department of Health.

(c) Full decertification of beds in a unit. The date the last patient was discharged from the unit.
 

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Section 441.84 - Date of change in certified bed capacity--increase

441.84 Date of change in certified bed capacity--increase. The date the hospital receives approval from the Department of Health to utilize a unit or portion thereof.
 

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Section 441.85 - Deductible

441.85 Deductible. Under the Medicare program, that portion of covered hospital and medical charges which an insured person must pay before his policy benefits begin. Proposed as a mechanism to discourage over-utilization or to avoid processing small claims.
 

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Section 441.86 - Deductions from revenue

441.86 Deductions from revenue. Reductions in gross revenue arising from bad debts, contractual adjustments, uncompensated/charity care, administrative, courtesy, policy discounts, adjustments and others.
 

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Section 441.87 - Deferral (or deferment)

441.87 Deferral (or deferment). The accounting treatment accorded the receipt or accrual of revenue before it is earned, or the incurrence of an expenditure before the benefits therefrom are received. Such items are balance-sheet liabilities or assets and are carried forward to the income account of succeeding periods as the revenue is earned or as the benefits are received from the expenditure.
 

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Section 441.88 - Deferred charge

441.88 Deferred charge. An expenditure not recognized as a cost of operations of the period in which incurred but carried forward to be written off in one or more future periods.
 

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Section 441.89 - Deferred credit

441.89 Deferred credit. Revenue received or recorded before it is earned, i.e., before the consideration is given, in whole or in part, for which the revenue is or is to be received.
 

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Section 441.90 - Depreciable cost

441.90 Depreciable cost. That part of the cost of a fixed asset that is to be spread over useful life; i.e., cost less the estimated recovery from resale or salvage.
 

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Section 441.91 - Depreciation

441.91 Depreciation. Lost usefulness; expired utility; the diminution of service yield from a fixed asset or fixed-asset group that cannot or will not be restored by repairs or by replacement of parts.
 

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Section 441.92 - Depreciation fund

441.92 Depreciation fund. Money or marketable securities set aside for the purpose of replacing or providing assistance in replacing depreciable fixed assets.
 

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Section 441.93 - Direct expense

441.93 Direct expense. The cost of any good or service that contributes to, and is readily ascribable to, product or service output. Direct expense includes salaries and wages, employee benefits, professional fees, supplies, purchased services, other direct expenses and transfers.
 

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Section 441.94 - Direct assignment of cost

441.94 Direct assignment of cost. The process of identifying and assigning costs directly to the functional cost center generating those costs.
 

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Section 441.95 - Discharge

441.95 Discharge. The termination of lodging and the formal release of an inpatient by the institution. Since deaths are a termination of lodging, they are also inpatient discharges.
 

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Section 441.96 - Discount earned

441.96 Discount earned. A reduction in the purchase price of a good or service because of early payment.
 

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Section 441.97 - Discrete unit

441.97 Discrete unit. A separately organized, staffed and equipped unit of the institution.
 

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Section 441.98 - Distribution

441.98 Distribution. (a) Any payment to stockholders or owners of cash, property or shares, including any of the various forms of dividends in noncorporate enterprise; a withdrawal.

(b) A spread of revenue or expenditure or of capital additions to various accounts; an allocation.

(c) Disposal of a product by sale.
 

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Section 441.99 - Donated commodities

441.99 Donated commodities. Gifts of supplies and other materials, such as medicines, blood, linen and office supplies, which are normally purchased by the institution, and are recorded on the books at their fair market value at the time of donation, regardless of when actual receipt takes place.
 

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Section 441.100 - Donated services

441.100 Donated services. The services performed by personnel who receive no compensation or partial compensation for their services. The equivalent of an employer-employee relationship must exist between the institution and the individual donating the services. The term is usually applied to services rendered, by members of religious orders, societies or similar groups, to institutions operated by or affiliated with such institutions.
 

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Section 441.101 - Due from other funds

441.101 Due from other funds. A receivable for money loaned, stores issued, work performed, or services rendered to or for the benefit of another fund.
 

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Section 441.102 - Due to other funds

441.102 Due to other funds. A payable for money borrowed, stores received, work performed, or services from another fund.
 

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Section 441.103 - Earned

441.103 Earned. Realized or accrued as revenue through sales of goods, services performed, or the lapse of time.
 

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Section 441.104 - Emergency outpatient

441.104 Emergency outpatient. An emergency outpatient is one who is admitted to the emergency, accident or equivalent service of the hospital for the diagnosis and/or treatment of a condition. The service is one operated pursuant to section 405.1033 of this subchapter.
 

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Section 441.105 - Emergency service category 4--basic emergency services

441.105 Emergency service category 4--basic emergency services. A physician beyond the first postdoctoral year and a registered nurse anesthetist or anesthesiologist must be available within 15 minutes of being called. Physicians with expertise in anesthesiology, surgery, internal medicine, pediatrics and obstetrics must be available within two minutes. The facility should have an ICU with 24-hour staffing by at least one registered nurse trained in emergency lifesaving techniques.
 

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Section 441.106 - Emergency services category 3--general emergency services

441.106 Emergency services category 3--general emergency services. In addition to the requirements for category 4 facility, a category 3 facility should have 24-hour in-house physician coverage and in-house storage of whole blood or packed red cells.
 

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Section 441.107 - Emergency services category 2--major emergency hospital

441.107 Emergency services category 2--major emergency hospital. In addition to meeting the qualifications for category 3 facility, a category 2 facility must also render resuscitation and extended critical care to patients. Also, intensive nursing care and basic intensive medical care, including 24-hour blood gas determinations and inhalation therapy services should be available.
 

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Section 441.108 - Emergency services category 1--comprehensive emergency medical services

441.108 Emergency services category 1--comprehensive emergency medical services. Comprehensive emergency medical services provide immediate, complete and advanced care for all patients, including those requiring the most complex and specialized techniques. In addition to meeting the qualifications of a category 2 facility, a category 1 facility should have an anesthesiologist, internist, surgeon and, if applicable, an obstetrician or pediatrician, all of whom are specially trained in resuscitation and are available 24 hours a day to the emergency department. Continuous 24-hour laboratory support should be available, including such services as the determination of blood gases, blood pH, cardiac output, oxygen consumption, oxygen content, plasma protein, serum electrolytes, blood volume. hematologic determination and blood sugar. Capability for hemodialysis and extracorporeal oxygenation must also be present.
 

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Section 441.109 - Empirical

441.109 Empirical. Derived from experience; sometimes contrasted with rational (i.e., derived from some plan or principle).
 

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Section 441.110 - Employee

441.110 Employee. As distinguished from an independent contractor, a person subject to the will and control of an employer with respect to what the employee does and how he does it, and who is on the payroll of the institution.
 

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Section 441.111 - Employee benefit

441.111 Employee benefit. A pension provision, retirement allowance, insurance coverage, paid vacation, sick leave, and holiday time off or other cost representing a present or future return to an employee, which is neither deducted on a payroll nor paid for by the employee.
 

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Section 441.112 - Encounter

441.112 Encounter. A face-to-face contact between a patient and a provider who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient.
 

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Section 441.113 - Endowment funds

441.113 Endowment funds. Funds in which a donor has stipulated, as a condition of his gift, that the principal of the fund is to be maintained inviolate and in perpetuity, and that only income from investments of the fund be expended (see also term endowment funds).
 

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Section 441.114 - Equity

441.114 Equity. (a) Any right or claim to assets.

(b) An interest in property or in a business, subject to claims of creditors.

(c) The difference between assets and liabilities.

(d) Net worth.
 

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Section 441.115 - Equity ownership

441.115 Equity ownership. (a) The interest of an owner in property or in a business or other organization, subject, in case of liquidation, to prior claim of creditors.

(b) The interest (paid-in capital and retained earnings) of a stockholder or of stockholders collectively in a corporation; proprietorship.
 

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Section 441.116 - Error

441.116 Error. Deviation, inaccuracy or incompleteness in the measurement or representation of fact.
 

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Section 441.117 - Estimated useful life

441.117 Estimated useful life. Expected operating or service life of an asset or asset group in terms of utility to the institution.
 

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Section 441.118 - Expenditure

441.118 Expenditure. (a) The incurring of a liability, the payment of cash, or the transfer of property for the purpose of acquiring an asset or service or settling a loss.

(b) The amount of cash or property paid or to be paid for a service rendered, or an asset purchased.

(c) Any cost, the benefits of which may extend beyond the current accounting period.
 

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Section 441.119 - Expense

441.119 Expense. Expired cost; any item or class of cost of (or loss from) carrying on an activity; a present or past experience defraying a present operating cost or representing an irrecoverable cost or loss.
 

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Section 441.120 - Expense center

441.120 Expense center. See cost center.
 

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Section 441.121 - Expired cost

441.121 Expired cost. An expenditure from which no further benefit is anticipated; an expense; a cost absorbed over the period during which benefits were enjoyed or a loss incurred.
 

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Section 441.122 - Extraordinary expense

441.122 Extraordinary expense. A material expense (see materiality) so unusual in nature or in frequency of occurrence as to be accorded special treatment in the accounts or separate disclosure in financial statements.
 

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Section 441.123 - Facility

441.123 Facility. A coordinated group of fixed assets--land, buildings, machinery and equipment constituting a plant.
 

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Section 441.124 - Fair market value

441.124 Fair market value. (a) Value determined by bona fide bargaining between well-informed buyers and sellers, usually over a period of time.

(b) An estimate of market value, in the absence of sales or quotations.
 

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Section 441.125 - FASB

441.125 FASB. Financial Accounting Standards Board.
 

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Section 441.126 - Fellow

441.126 Fellow. A graduate of a medical/osteopathic/dental school who has had an advanced period of graduate training and is in a fellowship program in a subspecialty or in a clinical research program.
 

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Section 441.127 - Fidelity bond

441.127 Fidelity bond. Insurance against losses arising from dishonest acts of employees involving money, merchandise or other property.
 

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Section 441.128 - Fiduciary

441.128 Fiduciary. Any person responsible for the custody or administration, or both, of property belonging to another; as, a trustee.
 

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Section 441.129 - Financial Accounting Standards Board (FASB)

441.129 Financial Accounting Standards Board (FASB). A quasi-independent organization established in 1973 by the AICPA-sponsored Financial Accounting Foundation for the purpose of developing principles for financial reporting by business enterprises.
 

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Section 441.130 - Financial statements

441.130 Financial statements. A balance sheet, income statement, funds statement, statement of changes in financial position, or any supporting statement or other presentation of financial data derived from accounting records.
 

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Section 441.131 - Financially indigent patient

441.131 Financially indigent patient. A patient lacking the financial ability to reasonably be expected to pay for medical services received.
 

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Section 441.132 - Fixed assets

441.132 Fixed assets. (a) Assets of a relatively permanent nature held for continuous use in hospital operations and not intended to be converted into cash through sales.

(b) A balance sheet classification denoting capital assets other than intangibles and investments in affiliated companies or other long-term investments.

(c) Included in the usual fixed-asset categories are land (from which the flow of services is seemingly permanent), land improvements, buildings, fixed equipment, tools, leasehold improvements, major movable and minor movable equipment; generally excluded are goodwill, patents, and other intangibles. The characteristic fixed asset has a limited life (land is the one important exception), and, in organizations where expenses are accounted for, its cost, less estimated salvage at the end of its useful life, is distributed over the periods it benefits by means of provisions for depreciation.
 

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Section 441.133 - Fixed capital

441.133 Fixed capital. The investment in capital assets.
 

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Section 441.134 - Fixed cost (or expense)

441.134 Fixed cost (or expense). An operating expense, or operating expense as a class, that does not vary with business volume. Examples: interest on bonds; rent; property tax; depreciation (sometimes in part); minimal amounts of general overhead. Fixed costs are not fixed in the sense that they do not fluctuate or vary; they vary, but from causes independent of volume.
 

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Section 441.135 - Fringe benefit

441.135 Fringe benefit. See employee benefit.
 

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Section 441.136 - Full-time equivalent employees (FTE)

441.136 Full-time equivalent employees (FTE). An objective measurement of the personnel employment of an institution in terms of full-time labor capability. To calculate the number of full-time equivalent employees, sum all hours for which employees were paid (whether worked or not) during the year and divide by 2080.
 

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Section 441.137 - Function

441.137 Function. A collection of activities having related purposes.
 

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Section 441.138 - Functional reporting

441.138 Functional reporting. Reporting of the revenues and expenses according to type of activity performed.
 

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Section 441.139 - Fund

441.139 Fund. A self-contained accounting entity set up to account for a specific activity or project.
 

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Section 441.140 - Fund accounting

441.140 Fund accounting. Maintenance of separate and/or group accounts for health facility resources according to spending objectives set by donors, other outside sources or the governing body.
 

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Section 441.141 - Fund asset

441.141 Fund asset. An asset belonging to a particular fund or a group of funds.
 

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Section 441.142 - Fund balance

441.142 Fund balance. The excess of assets over liabilities (net equity). An excess of liabilities over assets is known as a deficit in fund balance.
 

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Section 441.143 - Fund balance sheet

441.143 Fund balance sheet. A balance sheet divided into self-balancing sections, each of which shows the assets and liabilities of a single fund or group of related funds.
 

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Section 441.144 - Fund liability

441.144 Fund liability. A liability of a fund which is to be met out of its existing resources.
 

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Section 441.145 - Funded debt

441.145 Funded debt. Debt evidenced by outstanding bonds or long-term notes.
 

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Section 441.146 - Funded depreciation

441.146 Funded depreciation. See depreciation fund.
 

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Section 441.147 - Funded reserve

441.147 Funded reserve. A pension reserve, a reserve for bonuses or for the retirement of preferred stock, or other prospective future liability against which certain assets have been accumulated and set aside or earmarked.
 

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Section 441.148 - Funds held in trust by others

441.148 Funds held in trust by others. Funds held and administered, at the direction of the donor, by an outside trustee for the benefit of an institution or institutions.
 

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Section 441.149 - GAAP

441.149 GAAP. Generally accepted accounting principles.
 

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Section 441.150 - Gain or loss

441.150 Gain or loss. The net result of a concluded transaction or of an operating period following the application of generally accepted accounting principles.
 

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Section 441.151 - General fund

441.151 General fund. See operating fund.
 

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Section 441.152 - General journal

441.152 General journal. The journal in which are recorded transactions not provided for in specialized journals.
 

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Section 441.153 - General ledger

441.153 General ledger. A ledger containing accounts in which all the transactions of a business enterprise or other accounting unit are classified either in detail or in summary form.
 

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Section 441.154 - Generally accepted

441.154 Generally accepted. Given authoritative recognition; said of accounting principles or audit standards, and the pronouncements concerning them, particularly, in recent years, those of the American Institute of Certified Public Accountants and the Financial Accounting Standards Board.
 

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Section 441.155 - Gift

441.155 Gift. Any voluntary conveyance of assets gratuitously made and not in consideration of any kind of exchange.
 

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Section 441.156 - Goodwill

441.156 Goodwill. The excess of the price paid for a business as a whole over the book value or over the computed or agreed value of all tangible net assets purchased. Normally, goodwill thus acquired is the only type appearing on books of account and in financial statements.
 

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Section 441.157 - Governing board

441.157 Governing board. The policy-making board of the hospital. Some of the responsibilities usually attributed to the governing board may be assumed by appropriate committees.
 

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Section 441.158 - Gross

441.158 Gross. Undiminished by related deductions, except corrections; applied to sales, revenues, income, expense, and the like.
 

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Section 441.159 - Gross charges (gross revenue)

441.159 Gross charges (gross revenue). The total charges at the hospital's full established rates for services rendered and goods sold (including patient-related and non-patient-related).
 

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Section 441.160 - Gross square feet

441.160 Gross square feet. The total floor areas of the plant, including common areas (hallways, stairways, elevators, lobbies, closets, etc.).
 

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Section 441.161 - Health facility

441.161 Health facility. Any licensed facility, place or building which is organized, maintained and operated for the diagnosis, care and treatment of human illness, physical or mental, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, to which such persons are admitted for a 24-hour stay or longer.
 

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Section 441.162 - Health-related beds

441.162 Health-related beds. Beds in facilities providing institutional care and services with nursing services available, but not continuous. Refer to the definition of residential care in section 444.18(d)(7) of this Article.

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Section 441.163 - Health-related care

441.163 Health-related care. Care, other than medical, that is performed by qualified personnel and pertains to protective, preventive, personal and social services.

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Section 441.164 - Historical cost

441.164 Historical cost. The amount of cash or cash equivalent given in exchange for properties or services at the time of acquisition (see basis of valuation in section 442.10 of this Article).

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Section 441.165 - Holding account

441.165 Holding account. See clearing account.

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Section 441.166 - Home office

441.166 Home office. The office of the controlling organization. This office generally incurs costs and provides services to or on behalf of the individual health facility.

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Section 441.167 - Hospital

441.167 Hospital. An establishment that provides, through an organized medical or professional staff, permanent facilities that include inpatient beds, medical services and continuous nursing services, diagnosis and treatment for patients.
 

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Section 441.168 - Hospital-based physician

441.168 Hospital-based physician. A physician who spends the predominant part of his practice time within one or more hospitals instead of in an office setting, or providing services to one or more hospitals or their patients. Such physicians have either a special financial arrangement with the hospital (salary or percentage of fees collected), or bill patients separately for their services. Such physicians include directors of medical education, pathologists, anesthesiologists and radiologists, as well as physicians who staff emergency rooms and outpatient departments.
 

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Section 441.169 - Hospital boarder

441.169 Hospital boarder. An individual who receives lodging in the hospital but who is not an inpatient. In most hospitals, a small number of persons who are not patients and who are not hospital personnel or physicians may, nevertheless, be occasionally provided with room and board, often in "areas of the hospital where patients generally stay at least overnight". Most often this is arranged so that they can be near children or other members of the family who are ill.
 

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Section 441.170 - Hospital patient

441.170 Hospital patient. An individual receiving, in person or otherwise (telemetry), hospital-based or coordinated medical services for which the hospital is responsible.
 

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Section 441.171 - Imprest fund

441.171 Imprest fund. A fixed cash fund or petty cash fund in the form of currency, a bank checking account, or both, maintained for expenditures that must be made in cash, and, from time to time, restored to its original amount by a transfer from general cash of a sum equal to the aggregate of disbursements; a form of working fund.
 

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Section 441.172 - Improvement

441.172 Improvement. (a) Betterment.

(b) The clearing, draining, grading, or other addition to the worth of a tract of land; any cost of developing real estate, whether paid for directly or through special assessment taxes.

(c) A betterment of leased property or plant.
 

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Section 441.173 - Income realization

441.173 Income realization. The recognition of income, the usual test being the passage of title to or delivery of goods, or the performance of services.
 

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Section 441.174 - Income statement

441.174 Income statement. An accounting statement which reflects the financial results of a hospital during an accounting period. The data for this statement are accumulated in the revenue and expense accounts.
 

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Section 441.175 - Indirect liability

441.175 Indirect liability. (a) An obligation not yet incurred but for which responsibility may have to be assumed in the future; as, the possible liability from the premature settlement of a long-term contract.

(b) A debt of another, as the result of which an obligation to pay may develop; a contingent liability.
 

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Section 441.176 - Inpatient

441.176 Inpatient. A patient who is provided with room, board, and continuous general nursing service in an area of the hospital where patients stay overnight.
 

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Section 441.177 - Inpatient admission

441.177 Inpatient admission. The formal acceptance by a health facility of a patient who is to be provided with room, board, and continuous nursing service in an area of the health facility where patients generally stay at least overnight.
 

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Section 441.178 - Intangible asset

441.178 Intangible asset. A capital asset having no physical existence, its value being limited by the rights and anticipative benefits that possession confers upon the owner.
 

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Section 441.179 - Intensive care

441.179 Intensive care. Services provided in a routine patient care unit to patients which require extraordinary observation and care on a concentrated exhaustive and continuous basis.
 

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Section 441.180 - Interfund transfer

441.180 Interfund transfer. The transfer of money or other asset or of a liability from one fund to another.
 

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Section 441.181 - Intern

441.181 Intern. A graduate of a medical/osteopathic/dental school serving a first-year period of graduate clinical training.
 

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Section 441.182 - Internal control

441.182 Internal control. (a) The general methodology by which management is carried on within an organization; also, any of the numerous devices for supervising and directing an operation or operations generally.

(b) Internal control, a management function, is a basic factor operating in one form or another in the administration of every organization, business or otherwise. Although sometimes identified with the administrative organism itself, it is often characterized as the nervous system that activates overall operating policies and keeps them within practicable performance ranges. The principles contributing to internal control are usually these:

(1) recognition that within every organizational unit there are one or more functional or action components known as activities, costs, or responsibility centers, or management units;

(2) delegated operating authority in each organizational unit permitting freedom of action within defined limits;

(3) the linking of expenditures--their incurrence and disposition--with specified individual authority;

(4) end product planning by means of (i) a budget fitted to the organizational structure and to its functional components, thus maintaining dual forward operating disciplines; and (ii) the adoption of standards of comparison and other performance measurements such as standard costs, quality controls and timing goals;

(5) an accounting process that provides organizational and functional administrators with prompt, complete, and accurate information on operating performance, and comparisons with predetermined performance standards;

(6) periodic reports, consonant with accounting and related records, by activity heads to supervisory management; reports serving as feedbacks of informative pictures of operations, and as displays of favorable and unfavorable factors that have influenced performance;

(7) internal check, built into operating procedures, and providing maximum protection against fraud and error;

(8) frequent professional appraisals, through internal audit, of management and its policies and operations generally, as a protective and constructive management service, its emphasis varying with the quality of operating policies and their administration; and

(9) the construction of the above controls in such a manner as to stimulate and take full advantage of those natural attributes of individual employees the recognition and exercise of which may obviate the need for some internal controls and determine the extent and rigidity of others.
 

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Section 441.183 - Inventory control

441.183 Inventory control. The control of merchandise, materials, goods in process, finished goods, and supplies on hand by accounting and physical methods. An accounting control is effected by means of a stock or stores ledger, mechanical storage records, or a ledger account in which the quantities or amounts (or both) of goods received during an accounting period are added to corresponding balances at the beginning of the period and amounts of goods sold or otherwise disposed of are deducted at a calculated cost based on individual identification or any of various methods of averaging. Physical controls consist of various plans of buying, storing, handling, issuing, supervising and stock-taking. Stock-ledger control is made more effective by physical control in the nature of continuous check of the goods on hand.
 

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Section 441.184 - Inventory valuation

441.184 Inventory valuation. The determination of the cost or the portion of cost assignable to on-hand raw materials, merchandise, merchandise held for resale, and supplies based on any generally accepted method consistently applied.
 

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Section 441.185 - Invested capital

441.185 Invested capital. (a) The amount of capital contributed to a business by its owners; capital.

(b) The amount so contributed, plus retained earnings (or less accumulated losses) and appropriated surplus.
 

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Section 441.186 - Investor-owned (proprietary) hospital

441.186 Investor-owned (proprietary) hospital. A hospital owned by a person, an unincorporated group of people, or a corporation. Operation of this type of hospital is usually intended to return a monetary gain to the investors; but may include instances where individuals own and operate hospitals primarily for community benefit.
 

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Section 441.187 - Invoice

441.187 Invoice. A document showing the character, quantity, price, terms, nature of delivery, and other particulars of goods sold or of services rendered.
 

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Section 441.188 - Invoice cost

441.188 Invoice cost. Cost incurred by a buyer and reflected on an invoice which, unless otherwise specified, is net after deducting trade discounts.
 

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Section 441.189 - Irrevocable trust

441.189 Irrevocable trust. A trust that cannot be set aside by its creator.
 

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Section 441.190 - Lease

441.190 Lease. A conveyance of land or of the use of a building or a part of a building or equipment from one person (lessor) to another (lessee) for a specified period of time, in return for rent or other compensation.
 

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Section 441.191 - Leasehold

441.191 Leasehold. An interest in land, buildings and equipment under the terms of a lease, normally classified as a (tangible) fixed asset.
 

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Section 441.192 - Liability

441.192 Liability. (a) An amount owing by one person (a debtor) to another (a creditor), payable in money, or in goods or services: the consequence of an asset or service received or a loss incurred or accrued; particularly, any debt (1) due or past due (current liability), (2) due at a specified time in the future (e.g., funded debt, accrued liability), or (3) due only on failure to perform a future act (deferred income, contingent liability).

(b) The title of the credit half of a balance sheet, often including net worth as well as obligations to outsiders; when thus used, the inference is that the organization reflected in the balance sheet has a status independent of both its creditors and its owners--to whom it must account in the amounts shown.
 

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Section 441.193 - License

441.193 License. A permission granted by competent authority to engage in a business or corporation or any activity otherwise unlawful.
 

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Section 441.194 - Listing of accounts

441.194 Listing of accounts. A systematically arranged list of accounts applicable to a specific concern, giving names and numbers. See also chart of accounts.
 

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Section 441.195 - Live births

441.195 Live births. A live birth is the complete expulsion or extraction from its mother in a hospital facility, of a product of conception, irrespective of the duration of pregnancy, which after such separation breathes or shows any evidence of life such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
 

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Section 441.196 - Living trust funds

441.196 Living trust funds. Funds acquired by an institution subject to agreement whereby resources are made available to the institution on condition that the institution pay periodically to a designated person, or persons, the income earned on the resources acquired for the lifetime of the designated person or persons, or for a specified period.
 

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Section 441.197 - Maintenance

441.197 Maintenance. Effort expended to maintain assets in fit condition to do their work--such items are ordinary and recurring and do not improve the asset or add to its life. A useful distinction can be made between maintenance as preventive and repairs as curative.
 

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Section 441.198 - Materiality

441.198 Materiality. The relative importance, when measured against a standard of comparison, of all items (cumulative by cost center or account) included in or omitted from books of account or financial statements, or any procedure or change in procedure that conceivably might affect such statements. An amount is material if its exclusion from or inclusion in an accounting statement would make it misleading.
 

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Section 441.199 - Medicaid (Title XIX)

441.199 Medicaid (Title XIX). A federally aided, State-operated and administered program which provides medical benefits for certain low-income persons in need of health and medical care. The program, authorized by title XIX of the Social Security Act, is basically for the poor. It does not cover all of the poor, however, but only persons who are members of one of the categories of people who can be covered under the welfare cash payment programs--the aged, the blind, the disabled, and members of families with dependent children where one parent is absent, incapacitated or unemployed. Subject to broad Federal guidelines, states determine the benefits covered, program eligibility, rates of payment for providers, and methods of administering the program.
 

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Section 441.200 - Medical record

441.200 Medical record. A record kept on patients which properly contains sufficient information to identify the patient clearly, to justify his/her diagnosis and treatment, and to document the results accurately. The purposes of the record are to serve as the basis for planning and continuity of patient care; provide a means of communication among physicians and any professional contributing to the patient's care; furnish documentary evidence of the patient's course of illness and treatment; serve as a basis for review, study and evaluation; serve in protecting the legal interests of the patient, hospital and responsible practitioner; and provide data for use in research and education. Medical records and their contents are not usually available to the patient himself. The content of the record is usually confidential. Each different provider in a community caring for a given patient usually keeps an independent record of that care.
 

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Section 441.201 - Medical services

441.201 Medical services. The services pertaining to medical care that are performed at the direction of a physician on behalf of patients by physicians, dentists, nurses, and other professional and technical personnel.
 

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Section 441.202 - Medical staff classification--associate

441.202 Medical staff classification--associate. New applicants are generally appointed as associate staff members for a period of two to four years, after which they become members of the attending staff.
 

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Section 441.203 - Medical staff classification--attending

441.203 Medical staff classification--attending. Have full admitting privileges in accordance with their abilities and qualifications, and also participate as members of the medical staff committees, serve as officers of the medical staff and serve as directors or chiefs of departments. They are required to attend meetings of the general staff and departmental staff, and may be required to devote time to the education programs and supervise residents in outpatient clinics or emergency departments.
 

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Section 441.204 - Medical staff classification--consulting

441.204 Medical staff classification--consulting. Physicians of recognized professional ability in their specialty, but who are not members of the attending staff.
 

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Section 441.205 - Medical staff classification--courtesy

441.205 Medical staff classification--courtesy. Certain doctors are designated as courtesy members when they have retired. They have privileges consistent with their abilities and qualifications.
 

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Section 441.206 - Medical staff classification--house staff (paid staff)

441.206 Medical staff classification--house staff (paid staff). Licensed physicians who are employed by the hospital to provide service to all patients, according to need, and are subject to the approval of the patients' own physicians.
 

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Section 441.207 - Medicare

441.207 Medicare. A third-party reimbursement program administered by the Health Care Financing Administration that underwrites the medical costs of persons 65 and over, and some qualified persons under 65. "Part A" covers hospital services and "Part B" covers physicians' services.
 

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Section 441.208 - Mentally disordered patient

441.208 Mentally disordered patient. A person with a chronic psychiatric impairment and whose adaptive functioning is moderately impaired. This patient requires continuous supervision and can be expected to benefit from an active rehabilitation program effort designed to improve his adaptive functioning and develop a potential for replacement in a less protected living environment.
 

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Section 441.209 - Modernization

441.209 Modernization. Includes the alteration, expansion, major repair (to the extent permitted by regulations), remodeling, replacement and renovation of existing buildings (including initial equipment thereof and the replacement of obsolete equipment of existing buildings).
 

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Section 441.210 - Neonatal intensive care unit

441.210 Neonatal intensive care unit. A special unit, approved by the State, set up for the treatment of infants from hour of birth through first 28 days; also of infants up to three months of age with medical and surgical problems which are best managed in a neonatal intensive care unit.
 

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Section 441.211 - Net

441.211 Net. Diminished by all relevant and commonly associated deductions.
 

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Section 441.212 - Net square feet

441.212 Net square feet. Gross square feet of a building less common areas. To determine net square feet, the number of square feet in each cost center of the hospital may be determined either by a physical measurement of the hospital or by a measurement from blueprints. Floor area measurements should be taken from the center of walls to the center of adjoining corridors if a hallway services more than one cost center. Exclude stairwells, elevators, and other shafts, commonly used (lobbies, etc.) and idle areas. Idle areas are those areas that are closed off or unused for a period of time. Hallways, waiting rooms, storage areas, etc., serving only one cost center should be included in that cost center. The effect of using only usable space in the allocable floor area is to allocate the nonproductive space (commonly used and idle area) among the cost centers in the ratio of space used.
 

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Section 441.213 - Net worth

441.213 Net worth. The aggregate presentation on the accounting records of the equities representing proprietary interests; the excess of the going concern's value of assets over liabilities to outsiders; of a corporation, the total of paid-in capital, retained earnings, and appropriated surplus; of a sole proprietorship, the proprietor's account; of a partnership, the sum of the partners' accounts.
 

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Section 441.214 - Newborn

441.214 Newborn. (a) An inpatient newly born in the hospital and accepted for routine care and lodging in a newborn bed facility. Stillbirths are not to be considered newborn.

(b) The following should not be included as newborn patient days:

(1) boarder babies for nonmedical reasons;

(2) premature infants;

(3) infants born outside of hospital;

(4) newborn who, for medical reasons, remain in the hospital after the mother's discharge; and

(5) newborn who become sick and require general hospital care.
 

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Section 441.215 - Nine-C (IX-C) corporation

441.215 Nine-C (IX-C) corporation. As defined in article IX-C of the Insurance Law.
 

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Section 441.216 - Nonoperating expense

441.216 Nonoperating expense. The expenses of a hospital which are not directly related to patient care, related patient services, or the sale of related goods. For example, nonoperating expenses includes losses on sale of hospital property and retail operations expenses.
 

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Section 441.217 - Nonoperating revenue

441.217 Nonoperating revenue. The revenue of a hospital which is not directly related to patient care, related patient services, or the sale of related goods. For example, nonoperating revenue includes unrestricted gifts, unrestricted income from endowment funds, gain on sale of hospital properties, and retail operation revenue.
 

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Section 441.218 - Nonprofit corporation

441.218 Nonprofit corporation. An incorporated charity, or any corporation operated under a policy by which no stockholder or trustee shares in the profits or losses, if any, of the enterprise.
 

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Section 441.219 - Non-revenue-producing cost centers

441.219 Non-revenue-producing cost centers. These are overhead units, such as dietary and plant operations and maintenance, that provide necessary support services to revenue-producing centers.
 

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Section 441.220 - Nonroutine maintenance and repairs

441.220 Nonroutine maintenance and repairs. Maintenance and repair work which is not repetitive and not performed regularly.
 

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Section 441.221 - Not-for-profit

441.221 Not-for-profit. A corporation as defined in section 102 of the Not-for-Profit Corporation Law.
 

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Section 441.222 - Nursing services

441.222 Nursing services. Services pertaining to the curative, rehabilitative and preventive aspects of nursing care that are planned, performed, supervised and/or directed by a registered professional nurse.
 

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Section 441.223 - Obsolescence

441.223 Obsolescence. The loss in usefulness of an asset, occasioned by the approach to the stage of economic uselessness through programs of the arts; economic inutility arising from external causes; disappearing usefulness resulting from invention, change of style, legislation, or other causes having no physical relation to the object affected. It is distinguished from exhaustion, wear and tear, and deterioration, in that these terms refer to a functional loss arising out of a change in physical condition.
 

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Section 441.224 - Occasion of service

441.224 Occasion of service. (a) A specific identifiable act of service involved in the medical care of the patient which does not require the assessment of the patient's condition nor the exercising of independent judgment as to the patient's care. An example of an occasion of service is a technician administering an injection.

(b) An examination, a consultation or a treatment in any of the services or facilities of the hospital.
 

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Section 441.225 - On-call pay (standby)

441.225 On-call pay (standby). Standby pay is compensation to an employee for being available to work.
 

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Section 441.226 - Operating expenses

441.226 Operating expenses. Operating expenses include all necessary and proper costs which are appropriate in developing and maintaining the operation of the patient care facilities and activities. Necessary and proper costs related to patient care are those costs which are common and accepted occurrences in the hospital operation.
 

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Section 441.227 - Operating fund

441.227 Operating fund. The funds within the unrestricted fund which have not been designated by the governing board of the hospital for special uses.
 

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Section 441.228 - Operating income (or profit)

441.228 Operating income (or profit). The excess of the revenues of a business enterprise over the expenses pertaining thereto, excluding income and expense derived from sources other than its regular activities.
 

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Section 441.229 - Operating lease

441.229 Operating lease. A lease which fails to meet all of the following four criteria:

(a) The present value of the minimum lease payments is 90 percent of the fair value of the property to the lessor.

(b) The lease term is 75 percent or more of the leased property's estimated economic life.

(c) The lease contains a bargain (less than fair value) purchase option.

(d) Ownership is transferred to the lessee by the end of the lease term. (See FASB Statement No. 13 for further details.)
 

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Section 441.230 - Operating revenue

441.230 Operating revenue. Operating revenue includes revenue directly related to the rendering of patient care services and revenue from nonpatient care services to patients and sales and activities to persons other than patients.
 

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Section 441.231 - Organization cost (or expense)

441.231 Organization cost (or expense). Any cost incurred in establishing a corporation or other form of organization; as, incorporation, legal and accounting fees, promotional costs incident to the sale of securities, security qualification expense, and printing of stock certificates. These and similar costs constitute, theoretically, an intangible asset of value which continues throughout the life of the corporation and hence, strictly, do not constitute a deferred charge. The organization costs must be amortized over a period of time not less than 60 months.
 

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Section 441.232 - Original cost

441.232 Original cost. Outlay for an asset by its owner, not including any adjustments of cost arising from post-acquisition alterations, improvements or depreciation.
 

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Section 441.233 - Other operating revenue

441.233 Other operating revenue. Other operating revenue includes revenue from nonpatient care services to patients and sales and activities to persons other than patients, and the value of donated commodities.
 

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Section 441.234 - Outpatient

441.234 Outpatient. A hospital patient who receives services in one or more of the facilities of the hospital when he or she is not currently an inpatient or a home care patient.
 

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Section 441.235 - Outstanding

441.235 Outstanding. (a) Uncollected or unpaid: said of an account or note receivable or payable, or of a check sent to the payee but not yet cleared against the drawee bank.

(b) In the hands of others: said of the units of funded debt of a corporation or of the certificates representing issued shares of capital stock in the hands of the public; treasury stock is defined in terms of shares issued but not outstanding.
 

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Section 441.236 - Overhead

441.236 Overhead. (a) Any cost of doing business other than a direct cost of an output of product or service.

(b) A general name for costs of materials and services not directly adding to or readily identifiable with the product or service constituting the main object of an operation.
 

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Section 441.237 - Owner's equity

441.237 Owner's equity. Net worth.
 

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Section 441.238 - Ownership

441.238 Ownership. The right to and enjoyment of services or benefits flowing from an asset, usually evidenced by the possession of legal title or by a beneficial interest in the title.
 

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Section 441.239 - Oxygen therapy minutes

441.239 Oxygen therapy minutes. The number of minutes oxygen has been administered to a patient. Consideration should be given to volume of oxygen used.
 

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Section 441.240 - Paid-in capital

441.240 Paid-in capital. The total amount of cash, property and services contributed to a corporation by its stockholders and constituting a major balance sheet item. It may be reflected in a single account or divided between capital stock and additional paid-in capital accounts.
 

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Section 441.241 - Paid staff

441.241 Paid staff. See medical staff classification.
 

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Section 441.242 - Parent company

441.242 Parent company. A controlling company having subsidiaries. Without a trade or business of its own, a parent company may also be termed a holding company.
 

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Section 441.243 - Part A and Part B services

441.243 Part A and Part B services. Medicare benefits are payable from two trust funds. Part A services, which, in general, are those rendered by institutions, are reimbursed from funds derived from payroll tax. Part B services, generally medical and surgical physicians' services, and outpatient treatment and diagnosis are reimbursed from the fund created by voluntary premium payments and general Federal revenues.
 

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Section 441.244 - Patient care services revenue

441.244 Patient care services revenue. The hospital's full established charges for services rendered to patients regardless of amounts actually paid to the hospital by or in behalf of patients.
 

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Section 441.245 - Patient day

441.245 Patient day. A unit of measure denoting lodging facilities provided and services rendered to one inpatient between the census-taking hour on two successive days. The day of admission but not the day of discharge or death is counted as a patient day. 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.
 

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Section 441.246 - Payor

441.246 Payor. A person or organization which pays the hospital for services rendered to patients. This can be the patient and/or third party, such as Medicare, Medicaid, Blue Cross or other private insurance plan.
 

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Section 441.247 - Payroll

441.247 Payroll. (a) A record showing the wage or salary earned by employees for a certain period and the various deductions for withholding tax, health benefits, and so on.

(b) Total wages and salaries accrued or payable for a given period.
 

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Section 441.248 - Payroll distribution

441.248 Payroll distribution. (a) An analysis of the total amount of salaries and wages paid or accrued for a period, showing the component amounts to be charged to the various cost centers.

(b) The entry by which the amount of salaries and wages paid or accrued for a period is charged in the required detail to the accounts or records.
 

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Section 441.249 - Payroll records

441.249 Payroll records. The records relating to the authorization, computation, distribution and payment of wages and salaries. They include payrolls, time slips, time-clock cards, withholding authorizations, cancelled payroll checks or receipts for wages paid, wage and salary authorizations and individual earnings records.
 

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Section 441.250 - Pediatric patient

441.250 Pediatric patient. A patient less than 14 years old.
 

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Section 441.251 - Periodic interim payment (PIP)

441.251 Periodic interim payment (PIP). A plan under which the hospital receives cash payments from third-party payors (usually Medicare) in constant amounts each period. The total of these payments received over a year is the estimated cost of providing services to patients covered by the plan.
 

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Section 441.252 - Perpetual inventory

441.252 Perpetual inventory. A book inventory kept in continuous agreement with stock on hand by means of a detailed record that may also serve as a subsidiary ledger where dollar amounts as well as physical quantities are maintained. Sections of the stockroom are inventoried at short intervals and the quantities or amounts or both are adjusted, where necessary, to the physical count.
 

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Section 441.253 - Personal property

441.253 Personal property. Property or assets of a temporary and movable character as contrasted with real property.
 

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Section 441.254 - Physical inventory

441.254 Physical inventory. An inventory determined by observation and evidenced by a listing of the actual count, weight or measure.
 

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Section 441.255 - Physical life

441.255 Physical life. Total potential operating life, as of a machine, as contrasted with useful or economic life, which may be much less because of the presence of obsolescence or inadequacy, or both.
 

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Section 441.256 - Physician

441.256 Physician. A doctor of medicine or of osteopathy who is fully licensed to practice medicine.
 

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Section 441.257 - Physician, attending

441.257 Physician, attending. The physician who has legal responsibility for the care of a patient in a hospital.
 

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Section 441.258 - Physician, teaching

441.258 Physician, teaching. Physicians who have primary responsibility for teaching activities related to graduate physicians in training or medical/osteopathic/dental undergraduate students in an identified clinical service.
 

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Section 441.259 - Plant

441.259 Plant. Physical properties used for institutional purposes; i.e., land, building, improvements, equipment, and so forth. The term does not include real estate or properties of restricted or unrestricted funds not used for health facility operations.
 

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Section 441.260 - Plant replacement and expansion funds

441.260 Plant replacement and expansion funds. Resources restricted by donor and other third parties for the acquisition or construction of plant assets or the reduction of related debt.
 

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Section 441.261 - Pooled investments

441.261 Pooled investments. Assets of two or more funds consolidated for investment purposes.
 

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Section 441.262 - Premature infant

441.262 Premature infant. An infant born at any time through the 37th week of gestation (259 days).
 

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Section 441.263 - Premature nursery

441.263 Premature nursery. A separate facility, approved by the State, used exclusively for the care of infants whose birth weight is 2,500 grams or less.
 

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Section 441.264 - Prepaid expense

441.264 Prepaid expense. An expenditure, often recurrent, for future benefits; a type of deferred charge. Examples: prepaid operating expenses, prepaid rent, taxes, royalties, commissions; unexpired insurance premiums; stationery and office supplies. Such items are classifiable as current assets and constitute a part of working capital; they are charged to future operations on the basis of measurable benefits or on a time or period-charge basis.
 

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Section 441.265 - Prepay

441.265 Prepay. To pay for a service before its receipt or enjoyment; such prepayment, as for insurance or rent, reflecting long-established commercial practices, contrasts with accrue (or the recognition of the receipt or enjoyment of other types of services paid for after their receipt or enjoyment).
 

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Section 441.266 - Present value

441.266 Present value. The price a buyer is willing to pay for one or a series of future benefits, the term generally being associated with a formal computation of the estimated worth in the future of such benefits from which a discount or compensation for waiting is deducted.
 

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Section 441.267 - Prior-period adjustment

441.267 Prior-period adjustment. A correction of an error in earlier financial statements or an adjustment that results from realization of income tax benefits of pre-acquisition loss carry-forwards of purchased subsidiaries; all other items of profit or loss recognized in a fiscal year are required to be included in the determination of net income in the year recognized (see FASB Statement No. 16).
 

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Section 441.268 - Procedure

441.268 Procedure. A unit of activity in an ancillary cost center. For example, a procedure in a radiology cost center may be a series of pictures which constitute an exam.
 

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Section 441.269 - Professional component

441.269 Professional component. The professional services provided to patients by hospital-based physicians, as opposed to the education, research and administrative duties performed by the hospital-based physicians.
 

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Section 441.270 - Program

441.270 Program. Daily hospital or ambulatory service category of the patient.
 

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Section 441.271 - Provider

441.271 Provider. An individual or institution which gives medical care. Institutional providers include a hospital, skilled nursing facility and intermediate care facility. Individual providers include individuals (physicians, dentists, etc.) who practice independently of institutional providers and whose primary activity is the provision of health care to individuals.
 

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Section 441.272 - Psychiatric day care

441.272 Psychiatric day care. A program offering treatment including a planned program of recreational, social and vocational activities in a therapeutic environment under the direction of a psychiatrist or a physician with specialized knowledge in the field. Treatment services may be provided by a staff which may include psychiatrists, psychologists, social workers, nurses, educators, occupational and recreational therapists, psychiatric aides and volunteers. Treatment may include individual or group therapy, patient-staff meetings, drug therapy, occupational therapy, recreational therapy and other activity.
 

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Section 441.273 - Psychiatric inpatient service

441.273 Psychiatric inpatient service. The care of psychiatric inpatients; the hospital must also employ specially trained personnel to staff this service, and at least one psychiatrist must be on the medical staff.
 

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Section 441.274 - Psychiatric night care

441.274 Psychiatric night care. A program of inpatient care, similar to that described under psychiatric day care, and must include overnight stay in the facility.
 

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Section 441.275 - Radiology diagnostic films

441.275 Radiology diagnostic films. The total number of films used, including cardiac angiography exposures, mammography and xerography. Consideration should be given to the size of film used.
 

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Section 441.276 - Real estate (or property)

441.276 Real estate (or property). Land and land improvements, including buildings and appurtenances.
 

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Section 441.277 - Reclassification

441.277 Reclassification. The process of recasting a hospital's revenue and expense accounts into a new structure, e.g., moving from a responsibility to a functional arrangement. For purposes of this manual, the process of converting the hospital's accounts so as to comply with the prescribed reporting principles, definitions, listing of accounts and formats found in this manual. An audit trial of the conversion process must be maintained.
 

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Section 441.278 - Record

441.278 Record. A book or document containing or evidencing some or all of the activities of a hospital or containing or supporting a transaction, entry or account. Examples: a book of account; subsidiary ledger; invoice; voucher; contract; correspondence; internal report; minute book.
 

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Section 441.279 - Referred ambulatory

441.279 Referred ambulatory. A referred ambulatory patient is one who is treated and/or diagnosed in an ancillary service area of a hospital upon referral and who does not meet the definition criteria for an emergency outpatient or the clinical outpatient. A referral of an emergency or clinical outpatient to an ancillary service area does not change the classification of the patient to referred outpatient status.
 

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Section 441.280 - Rehabilitation beds

441.280 Rehabilitation beds. Beds assigned to a service for the primary purpose of assisting in the rehabilitation of disabled persons through a medical program integrated with psychiatric, social and vocational evaluation and services, under competent professional supervision.
 

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Section 441.281 - Religious corporation

441.281 Religious corporation. A corporation organized under the Religious Corporations Law, and other religious agencies and organizations, and charities, agencies and organizations operated, supervised or controlled by or in connection with a religious organization.
 

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Section 441.282 - Reporting manual

441.282 Reporting manual. A handbook of accounting policies, principles and concepts, including a chart of accounts with definitions and standard units of measure, which establishes a foundation for uniform reporting for health services institutions.
 

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Section 441.283 - Reporting period

441.283 Reporting period. The period of time for which an operating statement is prepared. This period shall consist of the 12 consecutive calendar months or 13 four-week periods that begin on the first day of a month with an additional day (two in a leap year) added to the last period to make it coincide with the end of the month.
 

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Section 441.284 - Reporting principles

441.284 Reporting principles. The body of doctrine associated with accounting, serving as an explanation of current practices and as a guide in the selection of conventions and procedures.
 

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Section 441.285 - Referred outpatient

441.285 Referred outpatient. An outpatient who is referred by his private physician to the institution for diagnosis or treatment on a ambulatory basis. The responsibility for medical care remains with the referring physician.
 

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Section 441.286 - Refund

441.286 Refund. An amount paid back or a credit allowed on account of an overcollection; rebate.
 

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Section 441.287 - Registration

441.287 Registration. The process of formally entering a patient's name on the institution's records for service in a routine outpatient care service area.
 

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Section 441.288 - Relative value unit

441.288 Relative value unit. Index number assigned to various procedures based upon the relative amount of labor, supplies and capital needed to perform the procedure. The unit value represents the cost of performing a service relative to some other service which is used as a base, i.e., has a unit value of one.
 

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Section 441.289 - Remuneration

441.289 Remuneration. Compensation for value of service rendered or expense incurred.
 

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Section 441.290 - Repair

441.290 Repair. (a) The restoration of a capital asset to its full productive capacity, or a contribution thereto, after damage, accident or prolonged use, without increase in its previously estimated service life or productive capacity.

(b) The charge to operations representing the cost of such restoration.
 

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Section 441.291 - Replacement

441.291 Replacement. The substitution of one fixed asset for another, particularly of a new asset for an old, or of a new part for an old part. On the books of account, the recognition of the cost of the new asset requires the elimination of the cost of the asset it replaces.
 

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Section 441.292 - Replacement cost

441.292 Replacement cost. (a) The cost of an acquired asset or asset part, capitalizable if the cost of its retired counterpart is removed from the asset account.

(b) The cost at current prices, in a particular locality or market area, of replacing an item or property or a group of assets.
 

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Section 441.293 - Reserve

441.293 Reserve. A segregation of retained earnings evidenced by the creation of a subordinate account. The segregation may be temporary or permanent, the purpose being to indicate to stockholders and creditors that a portion of retained earnings is recognized as unavailable for dividends. Examples: reserve for contingencies; reserve for improvements; sinking fund reserve.
 

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Section 441.294 - Resident

441.294 Resident. A graduate of a medical/osteopathic/dental school serving an advanced period of graduate training. This may represent the first year of graduate training or any year thereafter.
 

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Section 441.295 - Responsibility

441.295 Responsibility. The obligation prudently to exercise assigned or imputed authority attaching to the assigned or imputed role of an individual or group participating in organizational activities or decisions.
 

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Section 441.296 - Responsibility accounting

441.296 Responsibility accounting. An accounting system which accumulates and communicates historical and projected monetary and statistical data relating to revenues and controllable expenses, classified according to organizational units producing the revenues and responsible for incurring the expenses.
 

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Section 441.297 - Restricted funds

441.297 Restricted funds. Funds restricted by donors or grantors for specific purposes. Restricted funds generally fall into three categories: plant replacement and expansion fund, specific purpose fund, and endowment fund. The accounts within each restricted fund are self-balancing, as each fund constitutes a separate accounting entity.
 

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Section 441.298 - Retained earnings (or income)

441.298 Retained earnings (or income). Accumulated net income, less distributions to stockholders and transfers to paid-in capital accounts.
 

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Section 441.299 - Retirement

441.299 Retirement. The removal of a fixed asset from service, following its sale or the end of its productive life, accompanied by the necessary adjustment of fixed asset and depreciation-reserve accounts.
 

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Section 441.300 - Retirement of indebtedness funds

441.300 Retirement of indebtedness funds. Funds required by external sources to be used to meet debt service charges and the retirement of indebtedness on plant assets. The term sinking funds is sometimes used to describe these funds.
 

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Section 441.301 - Revenue

441.301 Revenue. Sales of products, merchandise and services, and earnings from interest, dividends and wages.
 

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Section 441.302 - Revenue center

441.302 Revenue center. An account for accumulating revenue consistent with the functional definition of the matching cost center.
 

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Section 441.303 - Revenue-producing cost centers

441.303 Revenue-producing cost centers. Health facility activities providing direct services to patients (such as nursing, physical therapy and laboratory) and thereby generating revenue.
 

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Section 441.304 - Routine

441.304 Routine. Regular; customary; ordinary; repetitive; everyday.
 

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Section 441.305 - Salvage value

441.305 Salvage value. The price at which an asset of any kind can be sold less whatever cost is yet to be incurred.
 

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Section 441.306 - Self-responsible (self-pay) patient

441.306 Self-responsible (self-pay) patient. A patient who pays either all or part of his hospital bill from his own funds as opposed to third-party funds.
 

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Section 441.307 - Self-insurance

441.307 Self-insurance. The assumption by a hospital of a risk arising out of the ownership of property or from other cause.
 

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Section 441.308 - Share of pooled investments

441.308 Share of pooled investments. The proportion of pooled investments, including accumulated gains or losses owned by a particular fund, usually expressed by a number (units) indicating the fractional ownership of total shares in the pool or by a percentage expressing the portion of the total pool owned by the particular fund.
 

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Section 441.309 - Sinking fund

441.309 Sinking fund. See retirement of indebtedness funds.
 

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Section 441.310 - Services

441.310 Services. (a) Sold services refers to ancillary services a hospital sells to other providers of health care services, rather than directly to the other provider's patients.

(b) It may also refer to other operating expenses, (i.e., laundry, data processing, etc.) which you sell to another organization (health care provider or commercial enterprise).
 

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Section 441.311 - Specific purpose funds

441.311 Specific purpose funds. Funds restricted by the donor for a specific purpose or project. Board-designated assets do not constitute specific purpose funds.
 

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Section 441.312 - Specimen

441.312 Specimen. Refers to the nature or source of material on which one or more laboratory tests may be carried out.
 

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Section 441.313 - Standard unit of measure

441.313 Standard unit of measure. The standard unit of measure is used to provide a uniform statistic for measuring and comparing hospital costs and productivity output, not activity.
 

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Section 441.314 - Standby pay (on-call)

441.314 Standby pay (on-call). Compensation paid to an employee for being available to work.
 

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Section 441.315 - Stepdown method

441.315 Stepdown method. The allocation of the accumulated costs of the nonrevenue producing centers to those other nonrevenue producing centers which utilize their services, as well as to the revenue producing centers to which they render service. Once the costs of a nonrevenue producing center have been allocated, that center is considered closed.
 

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Section 441.316 - Straight-line method of depreciation

441.316 Straight-line method of depreciation. This method of allocating depreciation is a function of the passage of time and recognizes equal periodic charges over the useful life of the asset. The depreciation charge calculated by the straight-line method is not affected by asset productivity, efficiency, or degree of use. The periodic charge is computed by relating the cost of the asset, less any salvage, to the useful life of the asset.
 

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Section 441.317 - Sub-acute care services.

441.317 Sub-acute care services. Services provided to patients who require a level of nursing care less than acute, including residential care.
 

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Section 441.318 - Subsidiary ledger

441.318 Subsidiary ledger. A supporting ledger consisting of a group of accounts the total of which is in agreement with a control account.
 

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Section 441.319 - Tangible assets

441.319 Tangible assets. A capital asset having physical existence.
 

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Section 441.320 - Teaching program (approved)

441.320 Teaching program (approved). A medical internship or residency training approved by the Council of 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 must have the approval of the Council on Dental Education of the American Dental Association.
 

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Section 441.321 - Teaching program (nonapproved)

441.321 Teaching program (nonapproved). To be a nonapproved teaching program means that, a medical internship or residency training program is not approved by the Council of 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. An intern or residency program in the field of dentistry is not approved unless approval has been received by the Council on Dental Education of the American Dental Association.
 

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Section 441.322 - Term endowment funds

441.322 Term endowment funds. Donated funds which by the terms of the agreement become available either for any legitimate purpose designated by the board or for a specific purpose designated by the donor upon the happening of an event or upon the passage of a stated period of time.
 

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Section 441.323 - Tests

441.323 Tests. Refers to each determination for which a specimen is analyzed. For example, a specimen for the SMA-12/60 is a single-patient serum on which 12 different tests are performed.
 

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Section 441.324 - Third-party payor

441.324 Third-party payor. An agency such as Blue Cross or the Medicare program which contracts with hospitals and patients to pay for the care of covered patients.
 

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Section 441.325 - Trade discount

441.325 Trade discount. The discount allowed to a class of customers on a list price before consideration of credit terms; as a rule, invoice prices are recorded in the books of account net after the deduction of trade discounts. Trade discounts are not to be confused with cash or purchase discounts which are other operating revenues.
 

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Section 441.326 - Transaction

441.326 Transaction. An event or condition the recognition of which gives rise to an entry in accounting records.
 

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Section 441.327 - Treasury stock

441.327 Treasury stock. Full-paid capital reacquired by the issuing company through gift, purchase or otherwise and available for resale or cancellation. Treasury stock is not a part of capital stock outstanding; and the term does not apply to unissued capital stock or to shares forfeited for nonpayment of subscriptions.
 

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Section 441.328 - Treatment

441.328 Treatment. A procedure performed on a hospital patient.
 

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Section 441.329 - Triage

441.329 Triage. The process of screening patients to determine the severity of the medical emergency and type of care necessary.
 

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Section 441.330 - Trial balance

441.330 Trial balance. A list or abstract of the balances or of total debits and total credits of the accounts in a ledger, the purpose being to determine the quality of posted debits and credits and to establish a basic summary for financial statements. The term is also applied to a list of account balances (and their total) abstracted from a customer's ledger or other subsidiary ledger for the purpose of testing their totals with the related control account.
 

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Section 441.331 - Trust

441.331 Trust. A right, enforceable in courts of equity, to the beneficial enjoyment of property, the legal title to which is in another.
 

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Section 441.332 - Trust fund

441.332 Trust fund. A fund held by one person (trustee) for the benefit of another pursuant to the provisions of a formal trust agreement.
 

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Section 441.333 - Tuberculosis beds

441.333 Tuberculosis beds. Beds assigned for the care and treatment of patients suffering from tuberculosis.
 

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Section 441.334 - Unit of service

441.334 Unit of service. (a) A unit of measure, often commonly accepted for determining average cost, time or efficiency, thus making possible: (1) comparisons of one operation with another or with the same operation in a preceding period; and (2) estimates of future operations.

(b) Synonymous with standard unit of measure.
 

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Section 441.335 - Unrealized revenue

441.335 Unrealized revenue. Revenue attributable to a completed business transaction but accompanied by the receipt of an asset other than cash or other form of current asset; as, an installment sale (gross revenue) or the prospective profit from such a sale (net revenue).
 

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Section 441.336 - Unrestricted funds

441.336 Unrestricted funds. Funds which bear no external restrictions as to use or purpose; i.e., funds which can be used for any legitimate purpose designated by the governing board, as distinguished from funds restricted externally for specific operating purposes, for plant replacement and expansion and for endowment.
 

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Section 441.337 - Useful life

441.337 Useful life. Normal operating life in terms of utility to the hospital.
 

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Section 441.338 - Vested interest

441.338 Vested interest. An interest (as a title to an estate) carrying a legal right to present or future enjoyment and of present alienation.
 

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Section 441.339 - Visit

441.339 Visit. The physical appearance of an outpatient at a hospital complex is recognized as contributing one visit regardless of the number of diagnostic and/or therapeutic services the patient receives or the number of sections (clinics), operating rooms, laboratories and treatment areas in which he/she receives them. The classification of the visit (i.e., emergency, clinic, etc.) will be determined by the first location where service is rendered. A patient referred from a physician's office exclusively for a specific ancillary service or services is classified as one referred ambulatory visit. A laboratory examination of a specimen sent in by a physician for his/her patient shall be included as one referred ambulatory visit.
 

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Section 441.340 - Wing

441.340 Wing. A distinct part of a building consisting of an architecturally subordinate extension of a building with a corridor connecting the main building and the extension. A wing could also be represented by the addition of one or more floors to an existing building.
 

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Section 441.341 - Zero level accounts

441.341 Zero level accounts. Accounts which have an account number with a fourth digit of zero.
 

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Part 442 - Reporting Principles And Concepts

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Section 2803-b

Section 442.1 - Purpose

Section 442.1 Purpose. The purpose of this Part is to establish a foundation for uniform reporting by hospitals. In making their reports, hospitals will be bound by the basic principles and concepts set forth in this Article. Any reporting principles and concepts not specifically discussed herein should be reported according to generally accepted accounting principles as interpreted in the opinions of the American Institute of Certified Public Accountants (AICPA) and in the statements by the Financial Accounting Standards Board.
 

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BASIC CONCEPTS

Section 442.2 - Accounting entity

BASIC CONCEPTS

442.2 Accounting entity. (1110) A fundamental reporting concept is that of the accounting entity or unit. For reporting purposes, the hospital is presumed to be an entity capable of buying, selling and taking other economic actions which are to be accounted for separately from the personal affairs of those responsible for the hospital's administration. The hospital itself is the primary unit for which the accounting records are maintained. However, most departments of the hospital usually assume sufficient importance to require separate treatment as subordinate entities or units of accountability for planning and control purposes.
 

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Section 442.3 - Continuity of activity

442.3 Continuity of activity. (1120) A basic reporting concept is that of continuity of activity, or the going concern. The assumption is that the hospital will continue to function indefinitely. It then becomes necessary to divide the life of the hospital into reporting periods, to determine revenues earned and expenses incurred during each period and to measure the amounts of assets and obligations at the end of each period.
 

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Section 442.4 - Reporting period

442.4 Reporting period. (1130) (a) For cost reporting purposes, the program will require submission of annual reports covering a 12-month period of operations based upon the provider's accounting year.

(b) The provider may select any annual period for cost reporting purposes as long as the reporting period selected is the same as that used for Medicare reimbursement. Once a provider has made a selection and reported accordingly, it is required thereafter to report annually for periods ending as of the same date, unless the intermediary approves a change in the provider's reporting period.

(c) A cost reporting period under the program consisting of one of the following will be considered in compliance with the reporting periods cited above:

(1) 12 successive calendar months;

(2) 13 four-week periods with an additional day (two in a leap year) added to the last week or period to make it coincide with the end of the calendar year or month; or

(3) a reporting period which will vary from 52 to 53 weeks because it must always end on the same day of the week (Monday, Tuesday, etc.) and always end on:

(i) whatever date this same day of the week last occurs in a calendar month; or

(ii) whatever date this same day of the week falls on which is nearest to the last day of the calendar month, even though this same day falls in the first week of the following month.

(d) The method selected must be consistently followed.

(e) A provider may prepare a short-period cost report for part of a year under the circumstances described in sections 2414.1 through 2414.3 of the Medicare Provider Reimbursement Manual (HIM-15), Part I.

(f) Providers in a chain organization, or other group of providers, are required to file individual cost reports.

(g) Upon entering the health insurance program, a new provider may select an initial cost reporting period of at least 1 month but not to exceed 13 months. For example, a new provider which starts with the Medicare program on September 15, 1974, and wishes to adopt a reporting period ending September 30, 1974, must file a report for the period September 15, 1974 to September 30, 1975. Such a provider cannot file a report for the 15-day period ending September 30, 1974.

(h) A hospital beginning operations must select an initial reporting period beginning on the first day of operation, through the last month preceding the hospital's selected fiscal year. For example, a hospital beginning operations August 15, 1980, selecting a fiscal year beginning January 1st, would have an initial fiscal period running from August 15, 1980 through December 31, 1980. It would then move to the standard January 1st to December 31st fiscal year.

(i) Whatever fiscal year is used for reporting purposes must coincide with that used for Medicare (Medicaid for Medicaid-only hospitals) cost reporting purposes.
 

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Section 442.5 - Objective evidence

442.5 Objective evidence. (1140) (a) Information produced by the accounting process should be based, to the extent possible, upon objectively determined facts. Transactions should be supported by properly executed documents such as charge slips, purchase orders, suppliers' invoices, cancelled checks, etc. Such documents serve as objective evidence of transactions and should be retained as a source of verification of the data in the accounting records.

(b) Certain determinations that enter into the accounting records are based on estimates. The estimates should be based on past experience modified by expected future considerations. Examples would include recognition of estimated provisions for depreciation and bad debts.

(c) Books, papers, records or other data relevant to matters of hospital ownership, organization and operation must be maintained. The data must be maintained in an ongoing recordkeeping system which allows for the data to be readily verified by qualified auditors.
 

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Section 442.6 - Conservatism

442.6 Conservatism. (1150) Conservatism is a quality of judgment to be exercised in evaluating the uncertainties and risks present in the hospital entity to assure that reasonable provisions are made for potential losses in the realization of recorded assets and in the settlement of actual and contingent liabilities. However, conservatism is not a justification for deliberate understatement.
 

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Section 442.7 - Consistency

442.7 Consistency. (1160) Consistency refers to continued uniformity, during a period and from one period to another, in methods of accounting, mainly in valuation bases and methods of accrual, as reflected in the financial statements of an accounting entity, e.g., change from FIFO inventory method to the LIFO method. Consistency is very important to the development and analysis of trends on a year-to-year basis and as a means of forecasting. However, consistency does not require continued adherence to a method of procedure that is incorrect or no longer useful, nor does it preclude a justifiable and desirable change in accounting and reporting methods or procedures unless otherwise specified in this manual. Any such change must be highlighted in submitting reports to HCFA by appropriate footnotes on all schedules which are affected by the change.
 

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Section 442.8 - Full disclosure

442.8 Full disclosure. (1170) The concept of full disclosure requires that all significant data be clearly and completely reflected in accounting reports. If, for example, a hospital were to change its method of accounting for certain transactions, within the limitations of this manual, and if the change had a material effect on the reported financial position or operating results, the nature of the change in method and its effect must be disclosed when reporting costs to any agency. No fact that would influence the decisions of management, the governing board, or other users of financial statements should be omitted from or concealed in accounting reports.
 

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Section 442.9 - Materiality

442.9 Materiality. (1180) Materiality is an elusive concept with the dividing line between material and immaterial amounts subject to various interpretations. It is clear, however, that an amount is material if its exclusion from the financial statements would cause misleading or incorrect conclusions to be drawn by users of the statements.
 

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Section 442.10 - Basis of valuation

442.10 Basis of valuation. (1190) (a) Historical cost is the basis used in accounting for the valuation of all assets and in recording all expenses (except fair market value in the case of donations and imputed value in the case of nonpaid workers). Historical cost, simply defined, is the amount of cash or cash equivalents given in exchange for properties or services at the time of acquisition. It is the basis for the valuation of assets and for the recording of most expenses. Cost ordinarily has been the basis for accounting for assets and expenses because it is a permanent and objective measurement that reflects the accountability of management for the utilization of hospital funds.

(b) Hospitals, however, frequently acquire property, equipment, services and supplies by donation. The property, equipment, service and/or supply is considered donated when acquired without the hospital making any payment for it in the form of cash, property or services. The property, equipment, service and/or supply should be valued at the fair market value which is the price that the asset would cost by bona fide bargaining between well-informed buyers and sellers at the date of donation (regardless of date of receipt). Failure to give accounting recognition to donated properties and services results in an understatement of hospital assets, revenues and expenses.

(c) Many hospitals receive the services of members of an organization of nonpaid workers that has arrangements with the hospital for the performance of services. The services are in positions customarily held by full-time employees, and are performed on a regularly scheduled basis. The fair value of donated services must be reported 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 must be evidenced by a contractual relationship which provides the basis for valuation. The amounts reported are not to exceed those paid others for similar work.

(d) The value of services of a type of which hospitals generally do not remunerate individual's performances are not included as operating cost (e.g., donated services of individuals such as volunteers and trustees).
 

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REPORTING PRINCIPLES

Section 442.11 - Accrual reporting

REPORTING PRINCIPALS

442.11 Accrual reporting. (1310) (a) In order to provide the necessary completeness, accuracy and meaningfulness in reporting data, accrual basis of accounting is required. Accrual accounting is the recognizing and recording of the effects of transactions and other events on the assets and liabilities of the hospital entity in the time periods to which they relate rather than only when cash is received or paid. For example, the writing off to expense each year of one third of the cost of a three-year insurance policy. We recognize that the immediate implementation of this policy may create a hardship for those hospitals currently on a cash basis. Because of this, a waiver of this rule will apply to cash basis hospitals for the first two reporting periods. At the end of this grace period, all reports must be on the accrual basis. Earlier compliance is encouraged.

(b) Requests for waivers of the accrual reporting requirement will be considered where a State law requires government hospitals to use other than full accrual accounting. The fiscal intermediary, after obtaining approval from the Health Care Financing Agency (HCFA), may grant such a waiver subject to review and revocation.
 

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Section 442.12 - Matching of revenue and expenses

442.12 Matching of revenue and expenses. (1320) (a) Determination of the net income of an accounting period requires measurements of revenue, revenue deductions and expenses associated with the period. Hospital revenue must be recorded in the period in which it is earned; that is, in the time period during which the services are rendered to patients and a legal claim arises for the value of the services.

(b) Once the revenue determination is made, a measurement must be made of the amount of expense incurred in rendering the services on which the revenue determination was based. Unless there is such a matching of revenue and expense, the reported net income of a period is meaningless.

(c) The requirement that revenue deductions must also be matched properly against the gross revenues of the reporting period is sometimes overlooked. During the reporting period, patients' accounts receivable will be debited and revenue accounts will be credited, at the hospital's full established rates, for all services rendered to patients. Some of these accounts receivable will remain unpaid at the end of the reporting period. A majority of these accounts will be collected in cash from the patients or from their third-party payors, but the remainder eventually will be written off as deductions from revenue.

(d) It is important that these revenue deductions be given accounting recognition in the same period that the related revenues were recorded, even though certain of these revenue deductions cannot be precisely determined.

(e) Revenue and expenses are to be matched not only for the hospital as a whole, but also for each cost center. The cost center is an accounting device for accumulating items of cost or revenue that have common characteristics. A cost center may or may not be a department within the hospital. A cost center such as depreciation is an example where the cost center would not be a department of the hospital. The costs of the functions and activities included in each cost center description are to be included in the cost center. Revenue relative to such functions and activities must be included in the matching revenue center. For example, expenses related to the clinical laboratory functions (activities) are included in the Laboratory Services-Clinical cost center (account 7210) and related revenue are to be included in Laboratory Services-Clinical revenue center (account 4210).

(f) Some hospitals record revenue on an all-inclusive rate basis (a rate based on type of accommodation regardless of the utilization of ancillary services). Utilization of an inclusive rate system results only in a modification of the patient billing and revenue accounting system. It does not eliminate the need to report expenses in the proper cost center. Those institutions which record charges on an all-inclusive rate basis are not required to report gross patient revenue for each patient care services revenue center. An all-inclusive rate charging system is where the hospital's total charges consist of a rate based on type of accommodation multiplied by length of stay regardless of the utilization of ancillary services.
 

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Section 442.13 - Deductions from operating revenue

442.13 Deductions from operating revenue. (1330) (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.

(b) These revenue adjustments are called Deductions from Revenue and are of the following primary categories:

(1) Provision for bad debts. These deductions represent the estimated amount of current revenues 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) Policy discounts. These deductions represent adjustments for items such as courtesy allowances and employee discounts from the hospital's full established charges for services.

(5) 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.

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

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Section 442.14 - Fund accounting

442.14 Fund accounting. (1340) (a) General.

(1) Many hospitals receive, from donors and other third parties, income, gifts, bequests and grants that are restricted as to use. When funds with donor-imposed restrictions are received, they must be reported separately. This would not preclude the pooling of assets for investment purposes.

(2) For balance sheet reporting, donor-restricted funds must be recorded separately in the appropriate restricted fund classifications. For income statement purposes, expenses relating to donor-restricted activities must be recorded in the Unrestricted Fund, and the earned share relative to such current year donor-restricted activities must be recorded as "Other Operating Revenue" unless otherwise restricted by covenant agreement. Hospitals receiving no restricted income, gifts, bequests or grants need not use separate fund accounting.

(3) Restricted funds generally fall into three categories: Plant Replacement and Expansion Fund, Specific Purpose Fund, and Endowment Fund. The accounts within each restricted fund are self-balancing, as each fund constitutes a separate subordinate accounting entity. The following sections outline the conditions and events which require separate accountability and the required accounting treatment for transactions within the established funds.

(b) Unrestricted Fund. (1341) (1) The Unrestricted Fund is used to account for funds derived from the day-to-day activities of the hospital and unrestricted contributions. Funds which originate from unrestricted gifts or previously accumulated income may be designated by the governing board for special uses. If the governing board designates assets in this manner, it should be recognized that the board also has the authority to rescind its action. For this reason, such funds must be accounted for in the Unrestricted Fund as "board-designated assets". All other funds within the Unrestricted Fund must be accounted for as operating funds. A separate structure of accounts in the Unrestricted Fund has been provided for operating funds and board-designated assets.

(2) The term restricted should not be used in connection with board or other internal hospital appropriations or designations of assets.

(c) Plant Replacement and Expansion Fund. (1342) (1) Resources restricted by donors and other third parties for the acquisition or construction of plant assets or the reduction of related debt must be accounted for in the Plant Replacement and Expansion Fund.

(2) When expenditures for plant assets are made by the Unrestricted Fund for the Plant Replacement and Expansion Fund, a transfer must be made from the Plant Replacement and Expansion Fund to match such expenditures if such funds are available. The entries to record such expenditures and the required transfer in both funds are as follows:

(i) Unrestricted Fund

June 30 Account Dr. Cr.

Construction in progress 1260 $1,000

Other accounts payable 2029 $1,000

Due from Plant Replacement and Expansion Fund 1073 $1,000

Transfer from restricted funds for capital outlay 2294 $1,000

(ii) Plant Replacement and Expansion Fund

Transfer to Unrestricted Fund for capital outlay 2695 $1,000

Due to Operating Fund 2581 $1,000

To record construction expenses incurred and related interfund transfer entries.

(3) Due to/due from accounts are to be used as an interim measure and should be reduced within a reasonable period of time by a transfer of assets (generally cash or investments) between the respective funds.

(i) Plant Replacement and Expansion Fund

July 3 Account Dr. Cr.

Due to Operating Fund 2851 $1,000

Cash 1510 $1,000

(ii) Unrestricted Fund

Cash 1010 $1,000

Due from Plant Replacement and Expansion Fund 1073 $1,000

To record transfer of cash from

Plant Replacement and Expansion

Fund to the Operating Fund.

(iii) Unrestricted Fund

July 5

Other accounts payable 2029 $1,000

Cash 1010 $1,000

To record payment of the liability.

(4) If cash is disbursed for plant assets directly from the Plant Replacement and Expansion Fund, the plant assets must nonetheless be recorded in the Unrestricted Fund, with the accompanying credit made to Fund Balance. In the Plant Replacement and Expansion Fund, fund balance would be debited, and a cash account credited. No entries would be made to the interfund payable or receivable accounts, nor would any cash be transferred between funds.

(5) The preferred method of accounting for the expenditure of restricted Plant Replacement and Expansion Funds is specified above. However, because of restrictions placed on construction funds by certain funding authorities, such expenditures and related liabilities are required to be recorded in the Plant Replacement and Expansion Fund. If expenditures for plant assets are recorded in the Plant Replacement and Expansion Fund, the plant assets must be transferred to the appropriate asset account in the Unrestricted Fund, with the accompanying credit made to the Unrestricted Fund balance. In the Plant Replacement and Expansion Fund, fund balance would be debited, and the temporary accounts(s) credited. No entry would be made to the interfund payable or receivable accounts. (Accounts have not been provided in this manual for recording such expenditures and related liabilities. Hospitals may establish such accounts as necessary.) (6) Income earned and any net realized gains on investments must be reflected as an addition to the fund balance if so specified by the donor. If available for general operating purposes, they must be included in nonoperating revenue in the Unrestricted Fund.

(d) Specified Purpose Fund. (1343) (1) Funds received which are restricted for a specific operating purpose must be accounted for in the Specific Purpose Fund. These resources must be recorded as other operating revenue in the period in which expenditures are made for the purpose specified by the donor.

(2) Income earned and any net realized gains on investments must be recorded as an addition to fund balance if required to conform to the donor's instructions or as nonoperating revenue of the Unrestricted Fund if such revenue is available for general purposes.

(e) Endowment Fund. (1344) (1) Funds classified as endowment include:

(i) pure endowment (principal is to remain intact in perpetuity);

(ii) term endowments (principal is available for use upon the passage of time or the occurrence of an event).

(2) When term endowments become available to the governing board for unrestricted purposes, they must be recorded as nonoperating revenue; if these funds are restricted, they must be transferred to the appropriate restricted fund.

(3) Income earned on endowment fund investments must be accounted for in accordance with donors' instructions if restricted, or as nonoperating revenue in the Unrestricted Fund if not restricted.

(f) Interfund Transactions. (1345) (1) As is shown in the Chart of Accounts, the only liability accounts included in the restricted funds (i.e., all funds other than the Unrestricted Fund) are liabilities to other funds (with the exception of the Endowment Fund, which allows for the inclusion of certain liabilities on Endowment Fund assets, and the Plant Replacement and Expansion Fund for certain covenant agreements as explained under number 1342).

(2) Thus, virtually all liabilities incurred by the hospital are to be recorded in the Unrestricted Fund. When these liabilities apply to restricted fund activities, a receivable from the applicable restricted fund must be recorded within the Unrestricted Fund. A payable to the Unrestricted Fund (or transfer of funds if paid immediately), as well as a reduction of the restricted fund balance, is recorded within the applicable restricted fund.

(3) Except for expenses incurred in conformity with covenant agreements, all expenses relating to restricted fund activities must be recorded in the Unrestricted Fund in the cost center category to which they apply. This is true whether the actual expenditures of cash are made from the Unrestricted Fund or a restricted fund. Separate cost centers must be established within each of these categories to record restricted activities for which separate accounting is required by the terms of the grant or gift. Sufficient account numbers have been allowed so that specific restricted fund activities may be segregated. Transfers from the restricted funds to match these expenses must be made in one of the following accounts:

(i) transfers from restricted funds for Research Expenses (account 5020);

(ii) transfers from restricted funds for Education Expenses (account 5280); or

(iii) transfers from restricted funds for Other Operating Expenses (account 5880).

(4) Example. In the following example, assume that $200 of consulting costs were incurred (this consulting was performed by a nonrelated organization) for restricted research activities, recorded as an expense and a liability in the Unrestricted Fund, and subsequently paid.

(i) Unrestricted Fund

June 1 Account Dr. Cr.

Research 8010 $200

Accounts payable 2020 $200

Due from Specific Purpose Fund 1074 $200

Transfers from restricted funds

for Research Expenses 5020 $200

(ii) Specific Purpose Fund

June 1

Transfers to Operating Fund for Operating Purposes 2797 $200

Due to Operating Fund 2781 $200

To record the expense and related liability for

costs incurred in restricted research activities

in the Operating Fund and record an interfund

liability and reduction in fund

balance in the Specific Purpose Fund.

(iii) Unrestricted Fund

June 10

Cash 1010 $200

Due from Specific Purpose Fund 1074 $200

(iv) Specific Purpose Fund

June 10

Due to Operating Fund 2781 $200

Cash 1710 $200

To record the transfer of

cash to the Operating Fund.

(v) Unrestricted Fund

June 15

Accounts payable 2020 $200

Cash 1010 $200

To record the payment of the liability.

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Section 442.15 - Long-term security investments

442.15 Long-term security investments. (1350) Long-term security investments are to be valued at hospital cost if purchased or, if acquired by donation, at the fair market value at the date of the gift. If there is evidence of a permanent decline in value, an appropriate reduction in carrying value must be made by charging the necessary expense account(s). The market value of long-term security investments at year-end must be disclosed.
 

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Section 442.16 - Pooled investments

442.16 Pooled investments. (1360) (a) Investments of various funds may be pooled unless prohibited by law or the terms of a donation or grant. Gains/losses and investment income on pooled investments must be distributed to participating funds on a basis utilizing market value.
(b) To illustrate the market value method of distributing gains/losses and income on pooled investments, assume the following facts:
(1) A hospital decides to create a pool of investments from funds provided from the following sources:
Market value at inception of pool*
Amount % of total pool
Unrestricted Fund $1,000,000 20%
Endowment Fund (single endowment) $3,000,000 60%
Plant Replacement and
Expansion (PR&E) Fund $1,000,000 20%
___________ _______
$5,000,000 100%
___________________________________________________________________________
*FOOTNOTE: This serves as the initial distribution basis.
___________________________________________________________________________
(2) Gains/losses on the Endowment Fund must be added to or deducted from the principal; however, the investment income is available for unrestricted purposes under the terms of the gift.
(3) Gains/losses and investment income for the Plant Replacement and Expansion Fund must be added to or deducted from fund balance pursuant to the wishes of the donor.
(4) There were no gains/losses on the sale of investments for the first year the pool was in existence. The income generated by the pool for that year was $400,000.
(5) Any gains on investment sales and investment income are not reinvested in the investment pool. The cash is remitted to funds that are entitled to the gains and/or income.
(c) The distribution of the income for the first year would be based on each participating fund's percentage of the pool based on its contribution at market value at the initiation of the pool.
(1) Therefore, the distribution would be as follows:
Income
Distributed to distributed
Unrestricted Fund (total income of $400,000 x 20%) $ 80,000
Endowment Fund (total income of $400,000 x 60%) 240,000
PR&E Fund (total income of $400,000 x 20%) 80,000
__________________
$400,000
(2) The accounting entries necessary to account for the distribution of income from the pooled investments would be as follows:
(i) Unrestricted Fund
Account Dr. Cr.
Cash 1010 $320,000
Unrestricted income from Endowment
Fund (nonoperating revenue) 9050 $240,000
Income, gains and losses from
unrestricted investments 9040 $ 80,000
To record the income from pooled
investments for the year.
(ii) PR&E Fund
Cash 1510 $ 80,000
Fund balance 2690 $ 80,000
To record the income from pooled investments for the year.
(d) In the second year the following facts are assumed:
(1) On the first day of the year the hospital decided to add $1,000,000 of Unrestricted Funds to the pooled investments. On that date, but prior to making the aforementioned addition, the pooled investments had the same cost, $5,000,000, as at inception, but a market value of $6,000,000. There were no other additions to the pool during this year.
(2) There were net gains on the sale of investments of $100,000 for the year and the investment income was $500,000 for the same period.
(e) Based on the above facts, the distribution percentage (%) for the income and gains on pooled investments for each of the participating funds would be based on the market value of the investment pool as of the date of the last addition and would be calculated as follows:
Revised
distribution basis
Units % of total units
(1) Unrestricted Fund.
Market Value $6,000,000 x 20%
(distribution % prior to addition) $1,200,000
Addition to pool at fair value
as of that date 1,000,000
____________
$2,200,000 31.4%
(2) Endowment Fund.
Market Value $6,000,000 x 60%
(distribution % prior to addition
-- no new additions) $3,600,000 51.4%
(3) PR&E Fund.
Market Value $6,000,000 x 20%
(distribution % prior to addition
-- no new additions) 1,200,000 17.2%
____________
$7,000,000 100.0%
(f) The income and gains from pooled investments for the second year would be based on the newly computed distribution and would be as follows:
Current Gains to be Income to be
distribution % distributed distributed
Unrestricted Fund 31.4% $ 31,400 $157,000
Endowment Fund 51.4% 51,400 257,000
PR&E Fund 17.2% 17,200 86,000
_______ __________ __________ 100.0% $100,000 $500,000
(g) The accounting entries necessary to reflect the above distribution would be as follows:
(1) Unrestricted Fund.
Account Dr. Cr.
Cash 1010 $445,400
Unrestricted income from Endowment Fund (nonoperating revenue) 9050 $257,000
Income, gains and losses from unrestricted investments 9040 188,400
To record the income and gains on pooled investments attributable to these funds for the year.
(2) Endowment Fund.
Cash 1810 $ 51,400
Fund balance (gains on sales of investments) 2890 $ 51,400
To record the gains on pooled investments attributable to this fund for the year.
(3) PR&E Fund.
Cash 1510 $103,200
Fund balance 2690 $103,200
To record the gains and income on pooled investments attributable to this fund for the year.
(h) As the above example illustrates, each time an addition is made to the investment pool a new distribution basis must be calculated. This is also true for any reductions to the pool. All gains/losses and investment income from the beginning of the accounting period up to the date of the addition must be determined and distributed on the basis of account balances prior to the addition. Any gains/losses and investment income subsequent to an addition would be distributed on the new basis until another addition or reduction is made.
 

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Section 442.17 - Inventories

442.17 Inventories. (1370) (a) Inventories reflect the cost of unused hospital supplies. Any generally accepted cost method (e.g., FIFO, LIFO, Average, etc.) may be used as long as it is consistent with that of the preceding accounting period. Cost of inventories based on the last invoice price is not an acceptable method for determining such cost.

(b) Inventory accounting record systems are required, consistent with the method of the inventory valuation employed. Perpetual inventory records are recommended but not required. Physical valuations must be made at least once a year and the accounting records, if applicable, adjusted to such valuations.

(c) Inventory usage records are required to be maintained for all inventories that are distributed and used by more than one cost center in the hospital. It is recommended that a formal requisition system be used for this purpose. In all cases, the cost of non-billable supplies used during the period must be distributed to the user cost centers, preferably on a monthly basis.
 

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Section 442.18 - Accounting for property, plant and equipment

442.18 Accounting for property, plant and equipment. (1380)

(a) Classification of fixed asset expenditures. (1381) Property, Plant and Equipment and related liabilities must be recorded in the Unrestricted Fund, since segregation in a separate fund would imply the existence of restrictions on the use of the asset. Cost of construction in progress and related liabilities must be recorded in the Unrestricted Fund as incurred except for assets and liabilities related to certain debt agreements.

(b) Basis of valuation. (1382) (1) Property, Plant and Equipment must be reported on the basis of cost. Cost shall be defined as historical cost or fair market value at the date of gift of donated property.

(2) Property, Plant and Equipment must be reported on the basis of the historical cost incurred by the present owner in acquiring the asset under a bona fide sale. The historical cost shall not exceed the lower of current reproduction cost adjusted for straight-line depreciation or fair market value at the time of purchase. See section 104.10 of HIM-15. Cost is defined as historical cost or fair market value of donated property on the date of acquisition.

(c) Accounting control. (1383) (1) To maintain accounting control over capital assets of the hospital, a plant asset ledger should be maintained as part of the general accounting records. Some items of equipment should be treated as individual units within the plant ledger when their individuality and unit cost justify such treatment. Other items of equipment, if they are similar and are used in a single cost center, may be grouped together and treated as a single unit within the ledger.

(2) All equipment purchased on or after the first day of a hospital's first accounting period beginning after the effective date of this manual, and all equipment purchased prior to such date where the necessary records have been maintained, must be segregated in the plant ledger record by cost center so that the cost of equipment and the related depreciation for each cost center is available.

(d) Capitalization policy. (1384) (1) If a depreciable asset has at the time of its acquisition an estimated useful life of three or more years and an historical cost of at least $300, its cost must be capitalized, and written off ratably over the estimated useful life of the asset.

(2) If a depreciable asset has an historical cost of less than $300, or if the asset has a useful life of less than three years, its costs are recorded in the year it is acquired, subject to the provisions of writing off the cost of minor movable equipment. The hospital may, if it desires, establish a capitalization policy with lower minimum criteria but under no circumstances may the above criteria be exceeded. Alterations and improvements in excess of $300 which extend the life a minimum of three years or increase the productivity or efficiency of an asset, as opposed to repairs and maintenance which either restore the asset to or maintain it at its normal or expected service life, must be capitalized and depreciated over their expected useful lives, not to exceed the lives of the asset to which they are fixed. Normal repair and maintenance costs are to be reported as expense in the current accounting period.

(3) For cost reporting periods beginning January 1, 1981 and thereafter, the historical cost limits will be adjusted to "an historical cost of at least $500 or, if it is acquired in quantity, the cost of the quantity is at least $1,000". The new $500 limit will also apply to alterations and improvements. All other principles cited above will continue in force.

(e) Minor equipment. (1385) (1) Minor equipment includes such items as wastebaskets, bedpans, silverware, mops, buckets, etc. The general characteristics of this equipment are:

(i) in general, no fixed location, and subject to use by various cost centers within a hospital;

(ii) comparatively small in size and unit cost;

(iii) subject to inventory control;

(iv) fairly large quantity in use; and

(v) generally, a useful life of less than three years.

(2) There are two ways in which the cost of minor equipment may be reported:

(i) The original cost of this equipment may be capitalized and not depreciated. Any replacements to this base stock would be reported as operating expenses. The amount of the base stock would be adjusted only if there were a significant change in the size of the base stock.

(ii) All purchases of minor equipment may be capitalized and depreciated over their estimated useful lives.

(3) Once a hospital has applied one of the methods, that method must be used consistently thereafter.

(f) Interest expense during period of construction. (1386) Frequently hospitals borrow funds to construct new facilities or modernize and expand existing facilities. Interest costs incurred during the period of construction must be capitalized as a part of the cost of the construction. The period of construction is considered to extend to the date the constructed asset is ready for use. When proceeds from a construction loan are invested and income is derived from such investments during the construction period, the amount of interest expense to be capitalized must be reduced by the amount of such income. (g) Depreciation policies. (1387) (1) Depreciation on plant assets used in the hospital's operations must be reported as an operating expense in the Unrestricted Fund. The straight line method of depreciation must be used for all assets acquired after July 1970. The estimated useful life of a depreciable asset is its normal operating or service life in terms of utility to the hospital. Some factors to be considered in determining useful life include normal wear and tear, obsolescence due to normal economic and technological advances, climatic or local conditions and the hospital's policy for repair and replacement.

(2) In selecting a proper useful life for computing depreciation, hospitals must utilize the most recent useful life guidelines published by the Secretary of the Department of Health and Human Services or, if none exist, the most recent guidelines published by the Internal Revenue Service or the 1973 guidelines published by the American Hospital Association. However, with the rapidly changing technology in hospitals, these recommendations may not be all-inclusive; in which case, the expertise of the manufacturer, or other reliable sources, may be considered. Any changes in estimated useful lives must be properly documented by the hospital and approved by the hospital's Medicare intermediary.

(3) For reporting purposes each hospital must establish, and follow consistently from year to year, a policy relative to the amount of depreciation to be taken in the year of acquisition and disposal of depreciable assets. Examples of acceptable policies are:

(i) Computing first year depreciation based upon the portion of time the asset was in use during the year. That is, if a depreciable asset was received and in use in the hospital for eight months in the year of acquisition, two thirds of a full year's depreciation expense would be recognized in that first year.

(ii) Recording one half of the yearly depreciation expense in the years of acquisition and disposal, regardless of the date of acquisition or disposal.

(4) Depreciation expense reported on buildings, purchased or constructed, in the year of acquisition or disposal must be based on the actual time during which the building was in use for hospital operations.
 

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Section 442.19 - Timing differences

442.19 Timing differences. (1390) (a) Timing differences result when accounting policies and practices used in an organization's accounting differ from those used for reporting operations to governmental units collecting taxes or to outside agencies making payments based upon the reported operations. These differences must be recorded on the hospital's records when they arise. The references relative to their acceptable accounting treatment are as follows:

--Income tax allocation--Accounting Principles Board Opinions Nos. 11, 23 and 24.

(b) The following condensed income statement illustrates a timing difference attributable to different methods of calculating depreciation expense for financial accounting versus tax or third-party reimbursement purposes.

(1) Assumptions:

(i) Depreciation for accounting purposes is calculated on the straight-line method and amounts to $10 for the current year.

(ii) Depreciation for tax and third-party reimbursement purposes is calculated on a declining balance method and amounts to $20 for the current year.

(iii) The tax rate is 40 percent.

(iv) The third-party utilization is 50 percent.

(v) The only deduction from revenue is the contractual allowance.

(2) Income statement.

Tax/third-party

Accounting records cost report

Revenue $180 $180

Deductions from Revenue 30 25

_____ _____

Net Revenue $150 $155

----- ----

Expenses (excluding depreciation) 110 110

Depreciation 10 20

_____ _____

Total Expenses before Taxes $120 $130

----- ----

Income before Taxes 30 25

Taxes 12 10

_____ _____

Net Income $ 18 $ 15

----- ----

(3) The income tax expense is comprised of three components:

$10 currently payable and $4 payable in future periods representing the tax effect of the difference between depreciation expense for accounting and tax purposes (40% x $10 = $4), and $2 to be applied against tax liabilities in future periods, representing the tax effect relative to reimbursement caused by the difference between depreciation for accounting purposes and cost report purposes, computed as follows: 40% (tax effect) x 50% (third-party utilization) x $10 (difference between depreciation for accounting and cost report purposes) = $2 or, stated another way, it is the difference between the deductions from revenue per the accounting records ($30) and the Tax/Cost Report Records ($25) times the tax rate of 40%.

(4) The journal entry to record these items is:

Account Dr. Cr.

Provision for income taxes

Federal - current 9411 $10

Provision for income taxes--

Federal - deferred 9412 2

Income taxes payable 2090 $10

Deferred income taxes payable 2120 2

(5) The deduction from revenue (contractual adjustments) is calculated as follows:

(i) Calculation.

Accounting Tax/cost

records report

Medicare revenue ($180 x 50%) $90 $90

Reimbursable costs:

$120 x 50% 60

$130 x 50% 65

____ ____

Contractual Adjustment $30 $25

(ii) Of the $30 contractual adjustment for accounting purposes, $25 is the current portion and $5 is the deferred portion.

(6) The journal entry to record this expense is:

Account Dr. Cr.

Contractual adjustment - Medicare 5910 $30

Allowance for contractual

adjustments - Medicare 1042 $25

Deferred revenue - Medicare 2131 5
 

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Section 442.20 - Accounting for pledges

442.2O Accounting for pledges. (1410) All pledges, less a provision for amounts estimated to be uncollectible, must be included in the hospital's accounting records. If unrestricted, they must be recorded as nonoperating revenue in the period the pledge is made. If part of the pledge is to be applied during some future period, that part must be recorded in the period the pledge is received as deferred revenue. If restricted, they must be recorded as an addition to the appropriate restricted fund balance. See Hospital Audit Guide.
 

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Section 442.21 - Self-insurance

442.21 Self-insurance. (1420) Self-insurance by a hospital for potential losses due to unemployment, workers' compensation and malpractice claims, asserted or otherwise, places all or part of the risk of such losses on the hospital rather than insuring against all or part of such losses with an independent insurer. For uniform reporting purposes for self-insurance, hospitals must follow the guidelines of Statement 5 of the Financial Accounting Standards Board.
 

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Section 442.22 - Related organizations

442.22 Related organizations. (1430) A hospital itself may be subsidiary to or under the control of a larger organization such as a university, governmental entity or parent corporation. It is typical in such situations for hospitals to receive services from these related organizations. Examples of services received are administration, purchasing, general accounting and menu planning. In addition, related organizations lease property, plant and equipment to hospitals as well as paying for various other items such as insurance. The related organization then usually charges for the service either directly or through a management fee. For uniform reporting purposes the direct charges must be reported as purchased services in the appropriate functional cost centers as billed, and the management fee must be reported in the functional cost centers in amounts relative to the services received for which the fee is paid.
 

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Section 442.23 - Debt financing for plant replacement and expansion purposes

442.23 Debt financing for plant replacement and expansion purposes. (1440) (a) Debt financing for plant replacement and expansion programs may take many forms. Under the terms of most debt financing agreements the debtor is required to perform or is prohibited from performing certain acts. In many instances, debt financing gives rise to special accounting treatment because of discounts and premiums on bond issues, financing charges, formal restrictions on debt proceeds, and sinking and other required funds.

(b) Discounts and premiums on bond issues. (1441) Discounts and premiums arising from the issue of bonds must be amortized over the life of the related issue(s). Bond discounts must be recorded as a reduction of the related debt (Bonds Payable - Net of Unamortized Discount). Bond premium must be recorded as Other Deferred Credits (account 2140).

(c) Financing charges. (1442) Costs of obtaining debt financing other than discounts (e.g., legal fees, underwriting fees, special accounting costs) must be recorded as deferred costs and amortized over the life of the related debt.

(d) Accounting for debt proceeds. (1443) (1) Debt agreements for financing plant replacement and expansion programs may or may not require formal segregation of debt proceeds prior to their use. Proceeds which are not required to be formally segregated prior to their use must be recorded as other noncurrent assets in the Unrestricted Fund.

(2) For the purposes of this Part, all funds received under covenant agreement arrangements which require formal segregation and/or separate accountability shall be recorded in the Plant Replacement and Expansion Fund until such time as the project is completed. Upon completion, the asset and related debt must be transferred to the Unrestricted Fund.

(e) Sinking and other required funds. (1444)

(1) These funds are usually established to comply with loan provisions whereby specific deposits are to be used to insure that adequate funds are available to meet future payments of:

(i) interest and principal (retirement of indebtedness funds); or

(ii) property insurance, related taxes, repairs and maintenance costs, equipment replacement (escrow funds).

(2) Funds of this nature may also be required to be held by trustees outside the hospital. Income generated from the investment of such funds may be immediately available to the hospital or such income may be held by the trustee for some future designated purpose.

(3) For the purposes of this Part, all sinking and other required funds will be accounted for in the following manner:

(i) All fund assets, whether trusteed or otherwise, must be recorded in the Unrestricted Fund as a long-term investment. The only exception is when the funds are restricted by covenant agreement.

(ii) All income generated from the investment of such funds must be recorded as nonoperating revenue in the Unrestricted Fund, except as required under number 1386. Income generated from funds under covenant agreement may be accounted for as an addition to the appropriate restricted fund balance account.

(f) Early debt retirement. (1445) (1) Many bond contracts provide for the calling of any portion or all of the issue at the option of the company at a stated price, usually above par, for the purpose of enabling the corporation to reduce its indebtedness before maturity as occasion arises, or to take advantage of opportunities to borrow on more favorable terms. Bonds are often retired piecemeal through sinking fund operations.

(2) Costs incidental to the recall of bonds before their date of maturity are considered debt cancellation costs. Such costs include bond recall penalties, unamortized bond discounts and expenses, legal and accounting fees, etc. These costs must be reduced by any unamortized bond premiums and recorded in the Unrestricted Fund in accordance with generally accepted accounting practices.
 

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SPECIALIZED REPORTING AREAS

Section 442.24 - Direct assignment of costs

SPECIALIZED REPORTING AREAS

442.24 Direct assignment of costs. (1610) (a) The direct assigning of costs is the process of identifying and assigning costs directly to the functional cost center generating those costs. Only those costs which meet the definitions and guidelines established within this section and in section 444.7 of this Article will be directly assigned.

(b) Buildings and fixtures. (1611) The cost of all depreciation or rent/lease of buildings and fixtures is to be charged to the Depreciation and Amortization Cost Center (account 8810) and to the Leases and Rental Cost Center (account 8815), respectively, and not reported as a direct expense of specific cost centers.

(c) Salary- and payroll-related employee benefits. (1612) (1) The salaries and wages cost must be assigned directly to the functional cost center to which the employee is assigned (see Natural Classification Accounts, section 444.23(b) of this Article). For example, for reporting purposes the salary cost of direct nursing services, including float nurses, must be directly assigned to the patient care cost centers receiving the service. This assignment may be based on each employee's actual nursing services, hours performed within each patient care cost center multiplied by that employee's hourly salary rate while performing the direct nursing service, or based on an analysis of salary and wage expense including time and cost studies.

(2) Payroll-related employee benefits must be reported in the cost center where the applicable employee's compensation is reported. This assignment can be performed on an actual basis or upon the following basis:

(i) FICA - actual expense by cost center;

(ii) pension and retirement and health insurance (non-union) - gross salaries of participating individuals by cost center;

(iii) union health and welfare - gross salaries of participating union members by cost center;

(iv) all other payroll-related benefits - gross salaries by cost center.

(3) Non-payroll-related employee benefits are to be reported in account 8830 (Employee Benefits--Non-Payroll-Related).

(d) Medical supplies and durable medical equipment. (1613) (1) The invoice/inventory cost of all medical and surgical supplies for which a separate charge is made, except home program dialysis supplies, must be reported as a cost of the Medical Supplies--Sold cost center (account 7110). The related revenue must be reflected in the Medical Supplies--Sold revenue center (account 4110). Home program dialysis supplies must be reported as a cost of the appropriate home program dialysis center.

(2) Medical and surgical supplies and materials issued by Central Services and Supplies for which a separate charge is not made must be reported at invoice/inventory cost as a cost of the cost center using the supplies and materials.

(3) Effective for cost reporting periods beginning January 1, 1982, the invoice/inventory cost of all durable medical equipment sold must be reported as a cost of the Durable Medical Equipment--Sold cost center (account 7130). The related revenue must be reported in the Durable Medical Equipment--Sold revenue center (account 4130).

(4) Effective for cost reporting periods beginning January 1, 1982, the depreciation expense associated with durable medical equipment leased or rented must be reported in the Durable Medical Equipment--Leased/Rented cost center (account 7140). The related revenue must be reported in the Durable Medical Equipment--Leased/Rented revenue center (account 4140).

(5) The overhead associated with the issuance of medical supplies and durable medical equipment must be reported in the Central Services and Supplies cost center (account 8460). The cost of reusable patient chargeable supplies must remain in the Central Services and Supplies cost center.

(e) Drugs. (1614) Pharmaceutical supplies and materials (including IV solutions, admixtures, blood derivatives, etc.) issued by the Pharmacy cost center for which a separate Pharmacy charge is made must be reported for as a cost of the Drugs Sold cost center (account 7150). The related revenue must be reflected in the Drugs Sold revenue center (account 4150).

Pharmaceutical supplies and materials (including IV solutions, admixtures, blood derivatives, etc.) issued by the Pharmacy for which a separate charge is not made must be reported at invoice/inventory cost as a cost of the cost center using the supplies and materials.

The overhead associated with the issuing of pharmaceutical supplies and materials (including IV solutions, admixtures, blood derivatives, etc.) must be reported in the Pharmacy cost center (account 8470). The cost of reusable patient chargeable items must remain in the Pharmacy cost center.

(f) Data processing. (1615) (1) All the direct costs incurred in operating an electronic data processing center, in purchasing data processing services, and/or in obtaining such services from related organizations, must be reported in the using cost centers. Direct cost which cannot be directly identified with specific functional cost centers must be assigned to the functional cost centers using such services based on each hospital's own determination of a fair and equitable assignment or allocation concept which gives appropriate recognition to the types of data processing costs incurred in their data processing center, under contract, and/or from related organizations. (2) Effective for cost reporting periods commencing January 1, 1981 or thereafter, this cost assignment or allocation concept must be agreed to by the medical fiscal intermediary prior to the end of the reporting period. Once a basis has been approved, it will remain in effect until the provider initiates a subsequent request to change it.

(3) No prior approval is required for cost reporting periods ending December 31, 1980 or before.

(g) Central patient transportation. (1616) (1) Because patient transportation costs are relatively minor in most hospitals, direct assignment of this expense is not required. Such expense may be reported where incurred. However, since no patient transportation cost center is provided, those hospitals which maintain a central patient transportation department must report such expenses in the appropriate ancillary services cost centers. Patient visits or some other valid basis may be used for reclassifying such expenses.

(2) The expenses incurred in transporting patients to the Daily Hospital Services areas at the time of admission are to be assigned to the Inpatient Admitting cost center (account 8524). The expenses incurred in transporting patients who have been discharged are to be assigned to the Daily Hospital Services functional cost center from which the patient was discharged.
 

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Section 442.25 - Hospital research and education costs

442.25 Hospital research and education costs. (1630) All direct costs incurred in conducting hospital research and formal educational activities (as opposed to in-service education) must be recorded in Unrestricted Fund cost center accounts 8010-8199 (Research Expenses) or 8220-8299 (Education Expenses).

(b) Grant accountability. (1631) When separate accounting is required by law, grant contract, or donations restricted for research and educational activities, separate cost centers must be maintained. Transfers from restricted funds to match the expenditures for these activities must also be segregated into separate accounts in the series 5020-5199 (Research) or 5280-5300 (Education). Thus, accountability is maintained for all restricted research and educational activities.

(c) Overhead allocation. (1632) (1) No allocation of indirect overhead is to be made on the books prior to cost reporting unless such allocation is required by grant contract. When a grant contract calls for the payment of direct costs plus an overhead factor, the overhead factor should be included in billing, but no allocation should be made in the hospital's accounting records.

(2) The following example illustrates the accounting treatment of restricted grant activity:

(i) Assume that a hospital received a specific research grant on December 1, which called for payment of direct costs incurred, plus an overhead allocation of 10 percent of such costs. At December 31 (the hospital's year-end), $150 of direct costs had been incurred. The following entries would be made in the hospital's accounting records at December 31:

(ii) Unrestricted Fund.

Account Dr. Cr.

Research 8010 $150

Cash 1010 $150

Due from Specific Purpose Fund 1074 $165

Transfer from restricted funds for research expenses 5020 $165

To record specific research direct costs and to set up receivable and

other operating revenue from restricted fund for direct costs, plus overhead allocation.

(iii) Specific Purpose Fund.

Fund balance - Transfers to Operating Fund for Operating

Purposes 2797 $165

Due to Operating Fund 2781 $165

To record liability to Unrestricted Fund for direct research costs and overhead allocation.

(3) If direct overhead must, by grant contract, be recorded in the Unrestricted Fund cost centers used for the recording of the direct costs of the grant activity, the natural expense classification .89 (other expenses) must be used. A separate cost center entitled "Overhead Applied" should be established in the Unrestricted Fund and credited with the amount of such overhead allocation. For reporting purposes the balance in the "Overhead Applied" cost center must be offset against the grant activity cost center, so costs remaining in the grant activity cost center are direct costs only.

(d) Affiliated school contracts. (1633) Education costs incurred relative to affiliated school contracts must be reflected in the Education series of accounts (8220-8299) in the Unrestricted Fund. Salaries, wages and stipends paid to students on approved programs (including interns and residents) must be reflected in this series of accounts. Salaries, wages and stipends paid to interns and residents must be reflected in the appropriate natural classification of the Postgraduate Medical Education cost centers (Approved account 8240 and Non-Approved - account 8250). Fees paid to physicians involved primarily in approved education programs must also be recorded in the Education series of accounts, in the appropriate cost center.
 

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Section 442.26 - In-service education--nursing

442.26 In-service education - nursing. (1660) (a) Nursing in-service education activities are defined as educational activities conducted by the hospital for hospital nursing personnel. The cost of time spent by nursing personnel as students in such classes and activities must remain in the cost center in which their normal salary and wage costs are charged (i.e., the cost center in which they work). However, the cost (defined as salary, wages and payroll-related fringe benefits) of time spent in such classes and activities by those instructing and administering the programs must be included in the Nursing Administration cost center (account 8750). For those hospitals that want to account for these costs separately, an In-service Education - Nursing subaccount (account 8751) has been provided.

(b) If instructors do not work full-time in the in-service programs, the cost (as defined above) of the portion of time they spend working in the in-service education program must be included in the Nursing Administration cost center. This may be accomplished by direct distribution of these costs (by natural classification of expense category) each payroll period based upon actual hours worked.

(c) The costs of nursing in-service education supplies (such as cassettes, books, medical supplies, etc.) and outside lecturers must also be reflected in the Nursing Administration cost center. Nursing in-service education does not include orientation of new employees. Such orientation costs must be charged to the cost center in which the new employees are, or will be, assigned.
 

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Section 442.27 - In-service education--nonnursing

442.27 In-service education - nonnursing. (1670) All expenses, including student and instructor salaries, associated with nonnursing in-service education activities must be included in the functional cost center to which the participating employees' salaries and wages are assigned, as such in-service educational activities will rarely apply to more than one functional activity.
 

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Section 442.28 - Physician remuneration

442.28 Physician remuneration. (1680) (a) Due to the numerous types of financial and work arrangements between hospitals and hospital-based physicians, comparability of costs between hospitals may be significantly impaired. This section deals with the methods to be used in recording costs and revenues related to the services of hospital-based physicians.

(b) Financial arrangements. (1681) (1) Although the variations in financial arrangements between hospitals and hospital-based physicians are endless, there are five general types of such arrangements:

(i) Agency arrangement. The hospital bills patients for the physician's professional services, but records these billings as liabilities and the subsequent payment to the physician as a reduction of that liability. The hospital reflects no operating revenue or expense relative to the professional component.

(ii) Compensation arrangement. The hospital bills patients for the physician's contractual professional services, including this amount as hospital revenue. All cost center expenses are paid by the hospital. The hospital remits a fee or pays a salary to the physician which is included in hospital expense. The compensation arrangement can be either fixed or variable. Under a fixed compensation arrangement the physician is paid a specific dollar amount (salary) unrelated to volume of services rendered. Under the variable compensation arrangement the physician's compensation will be a percentage of departmental gross charges or net collections. The actual compensation received by the physician will vary in proportion to the number of procedures performed and to the total charges made by the hospital. This arrangement includes those physicians providing patient services in the Daily Hospital Services cost centers.

(iii) Contracted arrangement. Under this arrangement, the physician may pay any or all expenses of the cost center. The hospital bills patients for the departmental services and remits a fee to the physician. This fee would typically be designed to cover the expenses incurred by the physician and are recorded as Professional Fees (Natural classification of expense .31) regardless of the expenses incurred by the physician.

(iv) Rental arrangement. The physician bills the patients for certain of the Part A and Part B component (as defined by Medicare) and incurs all substantial direct expenses. The physician remits a fee to cover certain hospital expenses. This fee is recorded as operating revenue in the appropriate revenue center.

(v) Independent/separate arrangement. The functions are provided by an independent physician or group of physicians. Neither revenues nor expenses are incurred by the hospital. The hospital refers patients and/or specimens to the physician or group, which is usually located on separate premises. No costs are incurred and no revenue is received under this arrangement.

(2) Note. Compensation paid to interns and residents is not to be included in the revenue producing cost centers, but must be charged to the Postgraduate Medical Education cost centers, accounts 8240 and 8250.

(c) Work arrangement. (1682) (1) The services provided by hospital-based physicians may be categorized into six general types.

(i) Professional component--providing direct patient care.

(ii) Education--teaching and supervising student activity in educational programs.

(iii) Research--working on research projects.

(iv) Medical care review--serving on the hospital's Medical Care Review Committee.

(v) Hospital administration--administering overall hospital activities (including hospital committees).

(vi) Cost center supervision--supervision and other activities of the cost center.

(2) When physicians are involved in more than one of the above functional activities, their remuneration, if any, must be recorded in the cost center for which services are paid. Prior to a trial balance under the Federal uniform reporting system, their remuneration must be reclassified to the appropriate cost centers.

(3) For example, if a physician is paid and spends 40 percent of his time in direct care of patients, 10 percent in educational activities, 15 percent in research, 5 percent in medical care review activities, 10 percent in administrative duties outside the department, and 20 percent in supervision of the department, the reclassification of his remuneration would be as follows:

(i) Distribution.

40 percent Physician's Professional Component (this amount must be reported in the Medical Staff Services cost center, account 8730).

10 percent Education Costs (to account 8220-8299).

15 percent Research Projects (to account 8010-8199).

5 percent Medical Care Review (to account 8740). 10 percent Hospital Administration (to account 8610).

20 percent Cost Center Supervision (remains in the cost center).

(ii) Computation. If the above physician is assigned to the Coronary Care cost center and is paid $50,000 annually, including employee benefits, the following reclassifications would be required for reporting purposes:

Professional Component 40% of $50,000 = $20,000--to account 8730

Education 10% of $50,000 = $5,000--to account 8220-8299

Research 15% of $50,000 = $7,500--to account 8010-8199

Medical Care Review 5% of $50,000 = $2,500--to account 8740

Hospital Administration 10% of $50,000 = $5,000--to account 8610

Cost Center Supervisor 20% of $50,000 = $10,000--remains in assigned cost center.

(4) The reclassification of the professional component from the assigned cost centers to the Medical Staff Services cost center, account 8730 is necessary in order to obtain comparable direct costs between hospitals which employ physicians and hospitals which do not.

(5) The reclassification of the other components is to obtain functional comparability.

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Section 442.29 - Periodic interim payments

442.29 Periodic interim payments. (1690) (a) Periodic interim payments are made biweekly to a hospital on the PIP program and are based on the hospital's estimate of applicable Medicare reimbursement for the current cost report period. When such payments are received, a cash account in the Unrestricted Fund is debited and a PIP Clearing Account (account 1051) is credited for the amount of the payment. When applicable Medicare charges are billed to the intermediary, the PIP Clearing Account is debited and patient accounts receivable is credited. At year-end, adjustments must be made to eliminate any remaining balance in the PIP Clearing Account and to reflect the amount receivable from, or due to, the Medicare intermediary.

(b) To illustrate these entries, assume the following facts:

(1) PIP payments during the year totaled $100,000, and applicable Medicare charges billed during the year were as follows:

Total charges $98,000

Noncovered charges 4,000

Deductibles and coinsurance 8,000

and

(2) Applicable unbilled Medicare charges and in-house patient balances were as follows at year-end:

Total charges $10,000

Noncovered charges 500

Deductibles and coinsurance 1,200

and

(3) Applicable reimbursable costs per the Medicare cost report prepared for the year were $92,000.

(c) In summary form, the accounting entries necessary to properly reflect the above transactions would be:

Account Dr. Cr.

(1) Cash 1010 $100,000

PIP Clearing Account 1051 $100,000

To record the receipt of PIP

payments during the year.

(2) Inpatient Receivables--

Discharged & Unbilled 1032 108,000

Various Revenue Accounts 108,000

To record applicable Medicare revenue for the year.

(3) PIP Clearing Account 1051 86,000

Inpatient Receivables--Other 1035 12,000

Inpatient Receivables--

Discharged & Unbilled 1032 98,000

To record the billing of Medicare charges to the intermediary ($86,000) and to Medicare patients for noncovered charges and deductibles and coinsurance ($12,000).

(4) PIP Clearing Account 1051 8,300

Inpatient Receivables--

Discharged & Unbilled 1032 8,300

To transfer the amount of applicable unbilled Medicare receivables at year-end to the PIP Clearing Account

($10,000 - $500 - $1,200).

(5) PIP Clearing Account--Medicare 1051 5,700

Contractual Adjustments--

Medicare 5910 5,700

To transfer the balance in the PIP Clearing Account at year-end to the Contractual Adjustments account (the PIP Clearing Account must be zero at year-end).

(6) Contractual Adjustments

Medicare 5910 17,200

Reimbursement Settlement 2071

Due--Medicare $17,200

To record the amount of cost report reimbursement settlement due, based upon cost report filed (total PIP payments of $100,000 and deductibles/coinsurance in the amount of $9,200, less $92,000 reimbursable inpatient costs per the cost report).

(d) Although the preceding illustration reflects year-end adjustments, similar entries should be made at the end of each month in order to properly reflect the amount of contractual adjustment during the year. In order to do this, cost reimbursement settlement must be estimated. When done at month-end, entries 4-6 would be reversed at the beginning of the next month.

(e) The above example adheres to the principle that, at year-end, the entire amount receivable from or payable to the intermediary by a provider under the PIP program must be reflected in account 1052.00 or 2061.00. There are no receivables "in-transit" under the PIP program. Although more complex systems of accounting for periodic interim payments and related billings are permissible--such as establishing separate subaccounts for: (1) PIP cash received; (2) Medicare PIP billings, including amounts unbilled at year-end; and (3) PIP contractual allowances--this basic principle must be followed.

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Part 443 - Listing Of Accounts

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Section 2803-b

Section 443.1 - Preface

Section 443.1 Preface. (2000) (a) A Listing of Accounts is a listing of account titles, with numerical symbols, used in the compilation of financial data concerning the assets, liabilities, capital, revenues and expenses of an enterprise.

(b) An outline of the required Listing of Accounts for hospitals is presented in this Part along with an explanation of the numerical coding system. A description of the nature and content of each account required to be used and reported is included in the Description of Accounts, Part 444 of this Article. It is recognized, however, that it is impossible to develop a Listing of Accounts that will fulfill all the requirements of all hospitals. Many hospitals will not require the detailed information provided for in the Listing of Accounts; others may require even more detailed classification. The Listing of Accounts is designed (at the zero level, except where noted) to provide the basis for a minimum standard of uniform accounting and reporting which will meet the needs of management, regulators, planners and others.

(c) Hospitals are required to use for reporting purposes all balance sheet accounts which have capitalized titles and which have numerical codes with a fourth digit of zero when such balance sheet items exist. These accounts are referred to as zero level accounts.

(d) Hospitals are required to use for reporting purposes all revenue and expense accounts which have capitalized titles and which have numerical codes with a fourth digit of zero when such a function as defined in this manual exists even though the activity is not separately organized within the hospital. The only circumstance under which the hospital need not report an existing zero level account is when the patient service provided in a daily hospital services cost center is not provided in a discrete unit.

(e) 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 wherever the related item or function exists in that hospital. A hospital will not be granted an exception to the establishment of an account solely because of reporting difficulty.
 

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Section 443.2 - Functional and responsibility concepts

443.2 Functional and responsibility concepts. (2010) In developing this Listing of Accounts, it was necessary to choose between functional and responsibility concepts of reporting. Both of these concepts result in the accumulation of the same amount of total costs. However, because organizational structures vary among hospitals, responsibility reporting would not allow for comparability. On the other hand, functions (Housekeeping, Dietary, Intensive Care, etc.) carried out by any hospital would be similar, thus a functional accounting system allows for comparability. For this reason, this Listing of Accounts is based upon functional reporting concepts.
 

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Section 443.3 - Numerical coding system

443.3 Numerical coding system. (2100) (a) General.

(1) The numerical coding system in the Listing of Accounts is based on the use of a six-digit numbering system. Account numbers include four digits to the left of a decimal point which identify primary account classifications, and two digits to the right which identify secondary account classifications.

(2) The numerical coding system also provides, for daily hospital and ancillary service revenue accounts only, that positions seven and eight can be used for designating the program in which the patient is being served as defined by the second and third digits of the daily hospital and ambulatory services numbers.

(3) The first digit of an account designates the financial statement classification of the account:

1--Assets

2--Liabilities, Equity, and Capital or Fund Balances

3--Daily Hospital and Ambulatory Services Revenue

4--Ancillary Services Revenue

5--Other Operating Revenue and Deductions from Revenue

6--Daily Hospital and Ambulatory Services Expenses

7--Ancillary Services Expenses

8--Research Expenses: Education Expenses; General Services Expenses; Fiscal Service Expenses; Administrative Services Expenses; Medical Care Administration Expenses; Other Operating Expenses

9--Non-Operating Revenue and Expenses

(4) The second, third and fourth digits of the daily hospital services, ambulatory services and ancillary services centers are the same for revenue and expense.

(b) Figures.

(1) Figure I - Numerical Coding System - Balance Sheet Accounts (Refer to 4876.159 H 12-31.80)

(2) Figure II - Numerical Coding System - Revenue Accounts (Refer to 4876.160 H 12-31-80)

(3) Figure III - Numerical Coding System - Expense Accounts (Refer to 4876.161 H 12-31-80)

(c) BALANCE SHEET ACCOUNTS (2110) The balance sheet coding uses only the first four digits appearing to the left of the decimal point. The two digits to the right of the decimal point are available for the optional use of the hospital.

(d) DAILY HOSPITAL AND AMBULATORY SERVICES (2130) The daily hospital and ambulatory services revenue allows the use of six digits--four to the left of the decimal and two to the right of the decimal. The digits to the left of the decimal represent the functional area serving the patient; the first digit to the right of the decimal represents the classification of service category of the patient service which the patient received and the second digit represents the primary payor for services rendered (Medicare--Part A, Blue Cross, Self Pay, etc.).

(e) ANCILLARY SERVICES REVENUE (2130) The ancillary services revenue allows the use of eight digits--four to the left of the decimal point and four to the right. The digits to the left of the decimal represent the ancillary service area rendering service; the first digit to the right of the decimal represents the classification of service category of the patient service which the patient received, and the second digit represents the primary payor for services rendered (Medicare--Part A, Blue Cross, Self Pay, etc.). The third and fourth digits to the right of the decimal point may be used to designate the program in which the patient is being served as defined by the second and third digits of the daily hospital and ambulatory services cost centers.

(f) OPERATING EXPENSE (2140) The expense coding uses six digits--four to the left of the decimal and two to the right. The digits to the left of the decimal represent the cost center incurring the expense. The digits to the right of the decimal represent the natural classification of expense. See Chapter III, sections 3300-3390 for explanation of digits representing the natural classification of expense.

(g) NON-OPERATING REVENUE AND EXPENSE (2150) Non-Operating revenue and expense consist of amounts not directly related to patient care, related patient services or the revenue and expense of related goods. The non-operating revenue and expenses coding uses the four digits appearing to the left of the decimal point. The digits to the right of the decimal are available for the optional use of the hospital.
 

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Section 443.4 - Listing of accounts--balance sheet

443.4 Listing of accounts--balance sheet. (2200)

CHART (Refer to 4876.163 H 12-31-80 through 4876.173 H 12-31-80)
 

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Section 443.5 - Listing of accounts--income statement

443.5 Listing of accounts--income statement. (2300) (a) For the new reporting requirements contained in the following subdivisions of this section, the initial reporting year is indicated in parentheses. For example, Accounts 3620/6620 - Skilled Nursing Care - Medicaid Certified in subdivision (b) paragraph (4) of this section has 1980 in parentheses. This means this cost center must be reported for the reporting period beginning in 1980 and thereafter. All other cost centers are required to be reported for reporting periods ending in 1979 and thereafter.

Account Number

Revenue Expense Account Title/(Reporting Year Effective)

(b) DAILY HOSPITAL SERVICES (2310)

(1) ACUTE CARE.

3010 6010 MEDICAL/SURGICAL ACUTE

3170 6170 PEDIATRIC ACUTE

3210 6210 PSYCHIATRIC ACUTE

3250 6250 OBSTETRICS ACUTE

3280 6280 DEFINITIVE OBSERVATION (1980)

3290 6290 OTHER ACUTE CARE

(2) INTENSIVE CARE.

3310 6310 MEDICAL/SURGICAL INTENSIVE CARE

3330 6330 CORONARY CARE

3331 6331 Myocardial Infarction

3332 6332 Pulmonary Care

3333 6333 Heart Transplant

3339 6339 Other Coronary Care

3350 6350 PEDIATRIC INTENSIVE CARE

3370 6370 NEO-NATAL INTENSIVE CARE

3380 6380 BURN CARE

3390 6390 PSYCHIATRIC INTENSIVE CARE

3410 6410 OTHER INTENSIVE CARE I

3420 6420 OTHER INTENSIVE CARE II (1980 Optional)

3430 6430 OTHER INTENSIVE CARE III (1980 Optional)

(3) NURSERY.

3510 6510 NEWBORN NURSERY

3520 6520 PREMATURE NURSERY

(4) SUB-ACUTE CARE

3610 6610 SKILLED NURSING CARE - MEDICARE OR MEDICARE/MEDICAID CERTIFIED (1980)

3620 6620 SKILLED NURSING CARE - MEDICAID CERTIFIED (1980)

3630 6630 PSYCHIATRIC LONG-TERM CARE

3640 6640 TUBERCULOSIS LONG-TERM CARE (1980)

3650 6650 INTERMEDIATE CARE - MENTALLY RETARDED (1982)

3660 6660 INTERMEDIATE CARE - OTHER (1980)

3670 6670 RESIDENTIAL CARE

3680 6680 OTHER SUB-ACUTE CARE SERVICES

3680 6680 OTHER SUB-ACUTE CARE HOSPITAL SERVICES (1982)

3690 6690 OTHER SUB-ACUTE CARE NON-HOSPITAL SERVICES (1982)

(c) AMBULATORY SERVICES (2320)

3710 6710 EMERGENCY SERVICES

3711 6711 Emergency Room

3712 6712 Observation

3719 6719 Other Emergency Services

3720 6720 CLINIC SERVICES

3721 6721 Allergy Clinic

3722 6722 Cancer Clinic

3723 6723 Cardiology Clinic

3724 6724 Dental Clinic

3725 6725 Dermatology Clinic

3726 6726 Diabetic Clinic

3727 6727 Drug Abuse Clinic

3728 6728 Ear, Nose and Throat Clinic

3729 6729 Eye Clinic

3731 6731 General Medicine Clinic

3732 6732 Obstetrics/Gynecology Clinic

3733 6733 Orthopedic Clinic

3734 6734 Pediatric Clinic

3735 6735 Physical Medicine Clinic

3736 6736 Psychiatric Clinic

3737 6737 Surgery Clinic

3738 6738 Urology Clinic

3739 6739 Venereal Disease Clinic

3799 6799 Other Clinic Services

3810 6810 Home Program Dialysis Equipment - 100% (1980)

3820 6820 Home Program Dialysis - Other (1980)

3830 6830 AMBULATORY SURGERY SERVICES

3840 6840 PSYCHIATRIC DAY AND NIGHT CARE SERVICES

3850 6850 AMBULANCE SERVICES

3860 6860 OTHER AMBULATORY SERVICES

3870 6870 FREE STANDING CLINIC

3880 6880 FREE STANDING CLINIC II (1980 Optional)

3890 6890 FREE STANDING CLINIC III (1980 Optional)

3910 6910 HOME HEALTH SERVICES - SKILLED NURSING CARE (1980)

3920 6920 HOME HEALTH SERVICES - MEDICAL SOCIAL SERVICES (1980)

3930 6930 HOME HEALTH SERVICES - HOME HEALTH AIDES (1980)

3990 6990 HOME HEALTH SERVICES - OTHER HOME HEALTH (1980)

(d) ANCILLARY SERVICES (2330)

(1) LABOR AND DELIVERY SERVICES.

4010 7010 LABOR AND DELIVERY SERVICES

(2) SURGICAL SERVICES GROUP.

4040 7040 SURGERY SERVICES

4041 7041 General Surgery

4042 7042 Open Heart Surgery

4043 7043 Neurosurgery

4044 7044 Orthopedic Surgery

4045 7045 Kidney Transplant

4046 7046 Other Organ Transplants

4049 7049 Other Operating Room Services

4060 7060 RECOVERY SERVICES (1980)

4080 7080 ANESTHESIOLOGY

(3) MEDICAL SUPPLIES AND EQUIPMENT GROUP.

4110 7110 MEDICAL SUPPLIES SOLD

4130 7130 DURABLE MEDICAL EQUIPMENT - SOLD (1982)

4140 7140 DURABLE MEDICAL EQUIPMENT - LEASED/RENTED (1982)

(4) DRUGS SOLD.

4150 7150 DRUGS SOLD

(5) LABORATORY SERVICES GROUP.

4210 7210 LABORATORY SERVICES - CLINICAL

4211 7211 Chemistry

4212 7212 Hematology

4213 7213 Immunology (Serology)

4214 7214 Microbiology (Bacteriology)

4215 7215 Procurement and Dispatch

4216 7216 Urine and Feces

4219 7219 Other Clinical Laboratories

4230 7230 LABORATORY SERVICES - PATHOLOGICAL

4231 7231 Cytology

4232 7232 Histology

4233 7233 Autopsy

4239 7239 Other Pathological Laboratories

4250 7250 WHOLE BLOOD AND PACKED RED CELLS (1980) 4260 7260 BLOOD STORING AND PROCESSING

(6) ELECTROCARDIOGRAPHY.

4290 7290 ELECTROCARDIOGRAPHY

(7) CARDIAC CATHETERIZATION.

4310 7310 CARDIAC CATHETERIZATION LABORATORY

(8) RADIOLOGY SERVICES GROUP.

4320 7320 RADIOLOGY - DIAGNOSTIC

4321 7321 Angiocardiography

4322 7322 Ultrasonography

4329 7329 Radiology - Diagnostic - Other

4340 7340 CT SCANNER

4360 7360 RADIOLOGY - THERAPEUTIC

4380 7380 NUCLEAR MEDICINE

4381 7381 Nuclear Medicine - Diagnostic

4382 7382 Nuclear Medicine - Therapeutic

(9) RESPIRATORY THERAPY.

4420 7420 RESPIRATORY THERAPY

(10) PULMONARY FUNCTION.

4440 7440 PULMONARY FUNCTION TESTING

(11) NEUROLOGY - DIAGNOSTIC.

4460 7460 NEUROLOGY - DIAGNOSTIC

4461 7461 Electroencephalography

4462 7462 Electromyography

(12) THERAPY SERVICES GROUP.

4510 7510 PHYSICAL THERAPY

4530 7530 OCCUPATIONAL THERAPY

4550 7550 SPEECH-LANGUAGE PATHOLOGY

4570 7570 RECREATIONAL THERAPY

4580 7580 AUDIOLOGY

4590 7590 OTHER PHYSICAL MEDICINE

4670 7670 PSYCHIATRIC/PSYCHOLOGICAL SERVICES

4671 7671 Individual Therapy

4672 7672 Group Therapy

4673 7673 Family Therapy

4674 7674 Biofeedback Training

4675 7675 Psychological Testing

4676 7676 Shock Therapy

4689 7689 Other Psychiatric/Psychological Services

(13) RENAL DIALYSIS.

4710 7710 RENAL DIALYSIS

4711 7711 Hemodialysis

4713 7713 Peritoneal Dialysis

4715 7715 Patient Dialysis Training

4719 7719 Other Dialysis

(14) ORGAN ACQUISITION AND OTHER.

4730 7730 KIDNEY ACQUISITION

4750 7750 OTHER ORGAN ACQUISITION

4910 7910 OTHER ANCILLARY SERVICES

(e) OTHER OPERATING REVENUE (2340)

5020 TRANSFERS FROM RESTRICTED FUNDS FOR RESEARCH EXPENSES

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

5280 TRANSFERS FROM RESTRICTED FUNDS FOR EDUCATION EXPENSES

5320 NON-PATIENT FOOD SALES (1980)

5330 LAUNDRY AND LINEN SERVICES REVENUE

5350 SOCIAL SERVICES REVENUE

5360 HOUSING REVENUE

5361 Employee Housing

5363 Student Housing

5440 PARKING REVENUE

5450 HOUSEKEEPING SERVICES REVENUE

5610 TELEPHONE AND TELEGRAPH REVENUE

5620 DATA PROCESSING SERVICES REVENUE

5690 PURCHASING SERVICES REVENUE

5710 SALE OF ABSTRACTS MEDICAL RECORDS

5760 DONATED COMMODITIES

5770 DONATED BLOOD

5780 CASH DISCOUNTS ON PURCHASES

5790 SALE OF SCRAP AND WASTE

5810 REBATES AND REFUNDS

5820 VENDING MACHINE COMMISSIONS

5830 OTHER COMMISSIONS

5840 TELEVISION/RADIO RENTALS

5850 NON-PATIENT ROOM RENTALS

5860 MANAGEMENT SERVICES REVENUE

5870 OTHER OPERATING REVENUE

5880 TRANSFERS FROM RESTRICTED FUNDS FOR OTHER OPERATING EXPENSES

(f) DEDUCTIONS FROM REVENUE (2350)

5900 PROVISION FOR BAD DEBTS

5910 CONTRACTUAL ADJUSTMENTS - MEDICARE

5911 Contractual Adjustments - Medicare - Part A

5912 Contractual Adjustments - Medicare - Part B

5920 CONTRACTUAL ADJUSTMENTS - MEDICAID

5930 CONTRACTUAL ADJUSTMENTS - BLUE CROSS

5940 CONTRACTUAL ADJUSTMENTS - OTHER

5950 CHARITY/UNCOMPENSATED CARE - HILL BURTON (1980)

5960 CHARITY/UNCOMPENSATED CARE - -OTHER (1980)

5970 RESTRICTED DONATIONS AND GRANTS FOR INDIGENT CARE (Credit Balance Sheet)

5980 ADMINISTRATIVE, COURTESY, AND POLICY DISCOUNTS AND ADJUSTMENTS

5990 OTHER DEDUCTIONS FROM REVENUE

(g) OTHER OPERATING EXPENSES (2360)

(1) RESEARCH EXPENSES.

8010 RESEARCH

(2) EDUCATION EXPENSES.

8220 NURSING EDUCATION

8221 Registered Nurses

8222 Licensed Vocational (Practical) Nurses

POSTGRADUATE MEDICAL EDUCATION - PRIMARY CARE TEACHING PROGRAMS - APPROVED:

8240 INTERNAL MEDICINE (1981)

8250 FAMILY PRACTICE (1981)

8260 PEDIATRICS (1981)

8270 POSTGRADUATE MEDICAL EDUCATION - OTHER APPROVED

TEACHING PROGRAM (1980)

8280 POSTGRADUATE MEDICAL EDUCATION - NON-APPROVED

TEACHING PROGRAMS (1980)

8290 OTHER HEALTH PROFESSION EDUCATION (1980)

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

(3) GENERAL SERVICES.

8310 DIETARY SERVICES

8320 NON-PATIENT FOOD SERVICE (1980) 8330 LAUNDRY AND LINEN

8350 SOCIAL WORK SERVICES (1980)

8360 HOUSING

8361 Employee Housing

8362 Nonpaid Workers Housing

8365 Student Housing

8400 PLANT MAINTENANCE (1982)

8410 PLANT OPERATIONS AND MAINTENANCE

8410 PLANT OPERATION (1982)

8411 Plant Operations

8412 Plant Maintenance

8413 Grounds

8430 SECURITY

8440 PARKING

8450 HOUSEKEEPING

8460 CENTRAL SERVICES AND SUPPLY (1980)

8470 PHARMACY

(4) FISCAL SERVICES.

8510 GENERAL ACCOUNTING

8520 PATIENT ACCOUNTS, ADMITTING AND REGISTRATION

8521 Patient Accounting

8522 Credit and Collection

8523 Cashiering

8524 Inpatient Admitting

8525 Emergency Room Registration

8526 Clinic Registration

8527 Referred Ambulatory Registration

8528 Other Outpatient Registration

8530 ADMITTING (1982)

8540 REGISTRATION (1982)

8541 Emergency Room Registration

8542 Clinic Registration

8543 Referred Ambulatory Registration

8549 Other Outpatient Registration

(5) ADMINISTRATIVE SERVICES.

8610 HOSPITAL ADMINISTRATION

8611 Office of Hospital Administrator

8612 Governing Board

8613 Public Relations

8614 Spiritual Care

8615 Communications

8616 Personnel

8617 Management Engineering

8618 Health Sciences Library

8619 Auxiliary Groups

8621 Data Processing

8690 PURCHASING AND STORES

8710 MEDICAL RECORDS

8720 MEDICAL STAFF ADMINISTRATION

8730 MEDICAL STAFF SERVICES

8740 MEDICAL CARE REVIEW

8741 PSRO

8749 Other Medical Care Review

8750 NURSING ADMINISTRATION

8751 In-service Education--Nursing

8759 Nursing Administration--Other

8760 MEDICAL PHOTOGRAPHY AND ILLUSTRATION

8780 FUND RAISING

(6) UNASSIGNED EXPENSE.

8810 DEPRECIATION AND AMORTIZATION

8811 Land Improvements

8812 Buildings and Improvements

8813 Leasehold Improvements

8814 Fixed Equipment Intangibles

8815 LEASES AND RENTALS (MANDATORY REPORTING)(1980)

8816 Land

8817 Buildings and Improvements

8818 Fixed Equipment

8820 DEPRECIATION AND AMORTIZATION--MOVABLE EQUIPMENT (1980)

8825 LEASES AND RENTALS--MOVABLE EQUIPMENT (MANDATORY REPORTING)(1980)

Account Number

Revenue Expenses Account Title/(Reporting Year Effective)

8830 EMPLOYEE BENEFITS--NON-PAYROLL RELATED (1980)

8840 INSURANCE--HOSPITAL AND PROFESSIONAL MALPRACTICE

8850 INSURANCE--OTHER

8860 LICENSES AND TAXES (OTHER THAN INCOME TAXES)

8870 INTEREST--SHORT-TERM

8880 INTEREST--LONG-TERM

(7) HOLDING ACCOUNTS.

8991 CENTRAL PATIENT TRANSPORTATION

8992 NURSING FLOAT PERSONNEL

8993 EMPLOYEE BENEFITS--PAYROLL RELATED

(h) NON-OPERATING REVENUE AND EXPENSE (2370)

9010 GAINS OR LOSSES ON SALE OF HOSPITAL PROPERTY

9020 UNRESTRICTED CONTRIBUTIONS

9030 DONATED SERVICES

9040 INCOME, GAINS, AND LOSSES FROM UNRESTRICTED INVESTMENTS

9041 Unrealized Gains and Losses on Marketable Securities

9050 UNRESTRICTED INCOME FROM ENDOWMENT FUNDS

9051 Unrealized Gains and Losses on Marketable Securities

9060 UNRESTRICTED INCOME FROM OTHER RESTRICTED FUNDS

9061 Unrealized Gains and Losses on Marketable Securities

9070 TERM ENDOWMENT FUNDS BECOMING UNRESTRICTED

9080 TRANSFERS FROM RESTRICTED FUNDS FOR NON-OPERATING EXPENSE

9110 DOCTORS' PRIVATE OFFICE RENTAL REVENUE

9120 OFFICE AND OTHER RENTAL REVENUE

9130 RETAIL OPERATIONS REVENUE

9150 OTHER NON-OPERATING REVENUE

9210 DOCTORS' PRIVATE OFFICE RENTAL EXPENSE

9220 OFFICE AND OTHER RENTAL EXPENSE

9230 RETAIL OPERATIONS EXPENSE

9240 MAINTENANCE OF NON-PAID WORKERS (1981)

9250 OTHER NON-OPERATING EXPENSE

9410 PROVISION FOR INCOME TAXES

9411 Federal--Current

9412 Federal--Deferred

9413 State--Current

9414 State--Deferred

9415 Local--Current

9416 Local--Deferred

9500 EXTRAORDINARY ITEMS
 

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Section 443.6 - Small hospital reduced reporting requirements

443.6 Small hospital reduced reporting requirements. (2380) (a) Small hospital is defined as a hospital or hospital-health service complex that has had, for the three accounting periods preceding the reporting period, average annual hospital admissions of less than 4,000.

(b) Such hospitals, at their option, may report less detail than that required for hospitals with average annual admissions of 4,000 or more. The reporting forms are the same for both small and large hospitals. However, small hospitals would group cost centers as specified below:

(1) Report as Plant Operation and Maintenance (account 8410) the combination of the following cost centers:

(i) Plant Maintenance (account 8400);

(ii) Plant Operation (account 8410);

(iii) Security (account 8430);

(iv) Parking (account 8440).

(2) Report as Patient Accounts (account 8520) the combination of the following cost centers:

(i) Patient Accounts (account 8520);

(ii) Admitting (account 8530);

(iii) Registration (account 8540).

(3) In place of the combination referred to in paragraph (2) of this subdivision, Hospital Administration (account 8610) may be reported by the combination of the following cost centers:

(i) General Accounting (account 8510);

(ii) Patient Accounts (account 8520);

(iii) Admitting (account 8530);

(iv) Registration (account 8540);

(v) Hospital Administration (account 8610);

(vi) Purchasing and Stores (account 8690);

(vii) Medical Staff Administration (account 8720).

(c) Paragraph (b)(1) of this section and either paragraph (b)(2) or (b)(3) must be utilized if this "small hospital" option is utilized.
 

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Section 443.7 - Natural classification of revenue

443.7 Natural classification of revenue. (2400) (a) The coding system for revenue provides for the use of six digits; four digits to the left of the decimal point and two digits to the right of the decimal point. In addition, for daily hospital service, ambulatory service and ancillary service revenue accounts only, positions seven and eight (third and fourth digits to the right of the decimal point) may be used for designating the program in which the patient is being served.

(b) Digit designations are as follows:

(1) First digit--indicates the primary account classification of the revenue account.

0-2 Not Used

3 Daily Hospital and Ambulatory Service Revenue

4 Ancillary Service Revenue

5 Other Operating Revenue and Deductions from Revenue

6-8 Not Used

9 Non-Operating Revenue

(2) Second through fourth digits (010-999)--indicate the primary subclassification of accounts.

(3) Decimal Point.

(4) Fifth digit--indicates the classification of service category of the patient service which the patient received.

.0 Inpatient - Acute Care

.1 Inpatient - Intensive Care

.2 Inpatient - Skilled Nursing Care

.3 Inpatient - Other

.4 Outpatient - Emergency

.5 Outpatient - Clinic

.6 Outpatient - Referred

.7 Home Health Care

.8 Day Care

.9 Non-Patient

(5) Sixth digit--indicates primary payor (admission status unless changed at later date) for patient as follows:

0--Medicare - Part A

1--Medicare - Part B

2--Medicaid

3--Other Government

4--Workers' Compensation

5--Blue Cross

6--Commercial Insurance

7--Charity/Uncompensated Care

8--Self Pay

9--Other

(6) Seventh and eighth digits--Used to designate program.

(7) Use of the sixth digit is unnecessary if logs are maintained.

(c) Examples of the coding of daily hospital and ancillary service revenue are as follows:

(1) A room and board charge made to a Pediatric Acute patient whose bill will be assumed by Blue Cross.

Daily Hospital Service Revenue

Pediatric Acute 1730

Decimal Point .

Inpatient Acute Care 0

Blue Cross 5

Pediatric Acute Care 17

or 3170.0517

(2) A laboratory charge (cytology) made to the same patient.

Ancillary Service Revenue 4

Pathological Laboratory (Cytology) 231

Decimal Point .

Inpatient Acute Care 0

Blue Cross 5

Pediatric Acute Care 17

or 4231.0517

(3) Digits seven and eight (e.g., 17) are optional digits indicating the program in which the patient is being served.
 

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Section 443.8 - Natural classification of expense

443.8 Natural classification of expense. (2500) (a) The coding system for expenses provides for the use of six digits: four digits to the left of the decimal point and two digits to the right of the decimal point. If two digits to the right of the decimal point are not sufficient for the individual hospital requirements, additional digits to the right of the decimal point may be added to obtain the desired detail.

(b) Digit designations are as follows:

(1) First digit--indicates the primary account classification of the expense account.

6 Daily Hospital and Ambulatory Service Expense

7 Ancillary Service Expense

8 Other

9 Non-Operation Expense

(2) Second through fourth digits (010-999)--indicate the primary subclassification of accounts.

(3) Decimal point--the two required digits (fifth and sixth digits as specified below) identify secondary account classifications.

(c) Natural classifications of expense (the fifth and sixth digits) are specified below:

(1) .00 Salaries and Wages.

.01 Management and Supervision

.02 Technician and Specialist

.03 Registered Nurses

.04 Licensed Vocational (Practical) Nurses

.05 Aides, Orderlies and Attendants

.06 Physicians

.07 Dentist

.08 Intern, Resident and Fellow

.09 Non-Physician Medical Practitioners

.11 Environment, Hotel and Food Service Employees

.12 Clerical and Other Administrative Employees

.19 Other Employee Classifications

(2) .20 Employee benefits.

.21 FICA

.22 SUI and FUI

.23 Group Health Insurance

.24 Group Life Insurance

.25 Pension and Retirement

.26 Workers' Compensation Insurance

.27 Union Health and Welfare

.28 Other Payroll Related Employee Benefits

.29 Employee Benefits (Non-Payroll Related)

(3) .30 Professional Fees.

.31 Medical--Physicians

.32 Medical--Therapists and Other Non-Physicians

.33 Consulting and Management Fees

.34 Legal Fees

.35 Audit Fees

.39 Other Fees

(4) .40 Medical and Surgical Supplies.

.41 Prostheses

.42 Surgical Supplies--General

.43 Anesthetic Materials

.44 Oxygen and Other Medical Gases

.45 IV Solutions

.46 Pharmaceuticals

.47 Radioactive Materials

.48 Radiology Films

.49 Other Medical Care Materials and Supplies

(5) .50 Non-Medical and Non-Surgical Supplies.

.51 Food--Meats, Fish and Poultry

.52 Food--Other

.53 Tableware and Kitchen Utensils

.54 Linen and Bedding

.55 Cleaning Supplies

.56 Office and Administrative Supplies

.57 Employee Wearing Apparel

.58 Instruments and Minor Equipment

.59 Other Non-Medical and Non-Surgical Supplies

(6) .60 Utilities.

.61 Electricity

.62 Fuel

.63 Water

.64 Disposal Service

.65 Telephone/Telegraph

.66 Purchased Steam

.69 Utilities--Other

(7) .70 Purchased Services.

.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

(8) .80 Other Direct Expenses.

.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

(9) .90 Depreciation/Rent.

.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

(d) Examples of coding for expenses are as follows:

(1) A registered nurse provides nursing care to a Pediatric Acute patient. The salary expense applicable to the registered nurse would be recorded as follows:

Daily Hospital Service Expense 6

Pediatric Acute 170

Decimal Point .

Salaries and Wages 0

Registered Nurses 3

or 6170.03

(2) A dietician prepares fish for serving to patients in a daily hospital service cost center. The salary expense applicable to the dietician would be recorded as follows:

Other Operating Expense 8

Dietary Services 310

Decimal Point .

Salaries and Wages 1

Environmental, Hotel and Food 1

Service Employee

or 8310.11

(3) The recording of the food (fish) prepared for the patients would be recorded as follows:

Other Operating Expense 8

Dietary Services 310

Decimal Point .

Non-Medical and Non-Surgical Supplies 5

Food--Meats, Fish and Poultry 1 or 8310.51
 

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Part 444 - Description Of Accounts

Effective Date: 
Tuesday, December 23, 1980
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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: 
Wednesday, January 23, 2002
Doc Status: 
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Part 445 - Account Distribution Index

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

Section 445.1 - Introduction

445.1 Introduction. (4000) (a) The account distribution index serves as a reference for proper classification of supplies and services expenses.

(b) (4001) The account distribution index is divided into two sections. Section 445.2 of this Part, "Job Titles by Natural Classification Index", lists various job titles and the natural classification of salaries and wages to which they must be charged as expenses. For example, the job title "accountant" requires that the salaries of an accountant must be charged to the natural classification .02 (Technician and Specialist).

(c) Section 445.3 of this Part, "Supplies and Services by Natural Expense Classification Index", lists various types of supplies and services and the cost center and natural classification to which they must be charged as expenses. In many cases, the cost center which originally receives the supply items is not the cost center to which the supply expense must be charged. For instance, although nonchargeable sutures may be received in the Central Service and Supply cost center and charged to inventory, upon requisition they are sent to an Operating Room cost center and their cost must be transferred interdepartmentally to that using cost center. It is this using cost center which is indicated in the Supplies and Services by Natural Expense Classification Index. All medical and surgical supplies and equipment expense related to patient chargeable items is to be charged to the Medical Supplies Sold cost center (account 7110), regardless of the cost center which actually issues the supplies. In order to have a matching of revenue and expense, the revenue related to the patient-chargeable supplies is to be credited to the Medical Supplies Sold revenue center (account 4110). All drug expense related to patient-chargeable pharmacy items is to be charged to the Drugs Sold cost center (account 7150) regardless of the cost center which actually issues the item. The revenue related to the patient-chargeable item is to be credited to the Drugs Sold revenue center (account 4150).

(d) Many of the items listed are not referenced to a single cost center, but to the "using" or "appropriate" cost center. These are items commonly used in more than one cost center, whose cost must be recorded directly or by interdepartmental transfer to the using cost center.
 

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Section 445.2 - Job titles by natural classification index

445.2 Job Titles by Natural Classification Index. (4200)

Job title Natural account number

Accountant .02

Accounting Clerk .12

Accounts Receivable Clerk .12

Addressing Machine Operator .12

Administrative Assistant .01

Administrative Secretary .12

Administrator .01

Admitting Officer .01

Ambulance Attendant .19

Ambulance Driver .19

Anesthesiologist .06

Animal Caretaker .19

Artist .02

Assistant Director .01

Associate Administrator .01

Audiologist .02

Audiometrist .02

Baker .11

Biochemist .02

Biochemistry Technologist .02

Biomedical Technician .02

Blood Bank Technologist .02

Boiler Repairman .11

Bookkeeper .12

Business Office Manager .01

Cardio-Pulmonary Technician .02

Carpenter .11

Cashier .12

Catheterisation Technician .02

Chaplain .19

Chef .11

Clerk, General .12

Clerk-Typist .12

Clinical Instructor .02

Clinical Coordinator .01

Coding Clerk .12

Collection Clerk .12

Communcations Coordinator .01

Computer Operator .02

Controller .01

Cook .11

Coordinator, Physical Medicine .01

Corrective Therapist .02

Correspondence Clerk .12

Counselor, School of Nursing .19

Cytotechnologist .02

Dark Room Attendant .19

Dental Assistant .02

Dental Hygienist .02

Dental Lab Technician .02

Dentist .07

Dialysis Technician .02

Diener (Morgue Attendant) .02

Dietetic Clerk .12

Dietician .02

Director .01

Dispatcher .12

Dispensary Clerk .12

Duplicating Machine Operator .12

Educational Therapist .02

EEG Technician .02

EKG Technician .02

Electrical Repairman .11

Electro-Medical Repairman .11

Elevator Operator .11

Employment Manager .01

Extern .19

Extractor Man .11

Fellow .08

File Clerk .12

Fireman, Boiler .11

Flatwork Finisher .11

Foreman .01

Grounds Keeper .11

Guard .11

Health Physicist .02

Heart-Lung Machine Operator .02

Hematologist .02

Hematology Technologist .02

Histologic Technician .02

Histopathologist .01

Hospital Admitting Clerk .12

Hospital Guide .19

Housekeeping Aide .11

Housekeeping Attendant .11

Housekeeping Crew Leader .01

Illustrator .02

Incinerator Man .11

Industrial Engineer .02

Inhalation Therapist .02

Inhalation Therapy Technician .02

Intern, Medical .07

Instructor .02

Insurance Clerk .12

Interviewer .12

Invoice Control Clerk .12 Job Analyst .02

Keypunch Operator .12

Laboratory Aide .19

Library Assistant .12

Licensed Practical Nurse .04

Mail Clerk .12

Maintenance Man Helper .11

Maintenance Mechanic .11

Manager .01

Manual-Arts Therapist .02

Market-Sorter .11

Medic .09

Medical Illustrator .02

Medical Laboratory Assistant .19

Medical Librarian .02

Medical Photographer .02

Medical Record Clerk .12

Medical Record Librarian .01

Medical Record Technician .02

Medical Secretary .12

Medical Stenographer .12

Medical Technologist .02

Medical Transcriptionist .02

Messenger .12

Microbiologist .02

Microbiology Technologist .02

Morgue Attendant .02

Music Therapist .08

Nuclear Medical Technologist .02

Nurse Anesthetist .02

Nurse, Head .01

Nurse, Practitioner .09

Nurse, Staff (RN) .03

Nursing Aide .05

Occupational Therapist .02

Occupational Therapy Aide .05

Optometrist .02

Orderly .05

Orthopedic-Appliance and Limb Technician .02

Orthopedic-Cast Specialist .02

Orthoptist .02

Painter, Maintenance .11

Paramedic .09

Parking Lot Attendant .11

Patient Food Service Worker .11

Patient Representative .12

Payroll Clerk .12

Personnel Assistant .12

Pharmacist .02

Pharmacy Helper .12

Physical Therapist .02

Physical Therapy Assistant .02

Physician .06

Physician's Assistant .09

Plasterer, Maintenance .11

Plumber, Maintenance .11

Podiatrist .19

Porter .11

Presser, Hand .11

Press Operator .11

Printer .02

Programmer .02

Prosthetist-Orthotist .02

Psychologist .19

Public Information Specialist .02

Pulmonary Function Technician .02

Purchasing Agent .01

Radiation Monitor .02

Radiologic Technician .02

Receptionist .12

Recreational Therapist .02

Recreation Director .02

Refrigeration Mechanic .19

Residence Director .19

Resident, Medical .07

Respiratory Therapist .02

Salad and Dessert Preparer .11

Seamstress .11

Secretary .12

Serologist .02

Shaker .11

Social Work Assistant-Case Aide .19

Social Worker .02

Speech and Hearing Therapist .02

Speech Clinician .02

Speech Pathologist .02

Stationary Engineer .11

Statistical Clerk .12

Stenographer .12

Stock Clerk .12

Supervisor .01

Surgical Technician .02

Systems Analyst, Data Processing.02

Tab Operator .02

Telephone Operator .12

Therapy Technician .02

Thermographic Technician .02

Training Officer .01

Transcribing Machine Operator .12 Truck Driver .11

Tumbler Operator .11

Typist .12

Veterinarian .19

Wall Washer .11

Ward Clerk .12

Washman .11

Window Washer .11
 

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Section 445.3 - Supplies and services by natural expense classification index

445.3 Supplies and Services by Natural Expense Classification Index. (4300)

CHART - (refer to pages 4876.278 H 12-31-80 through 4876.313 H 12-31-80)
 

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Part 446 - Reporting Requirements

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

REPORTING REQUIREMENTS

Section 446.1 - Introduction

Section 446.1 Introduction. (a) Public Law 95-142, section 19, requires that for the purposes of reporting the cost of services provided by, of planning and of measuring and comparing the efficiency of and effective use of services in, hospitals, the Secretary of Health and Human Services shall establish by regulation a uniform system for reporting certain types of information. It further states that in reporting under such a system, hospitals shall employ such chart of accounts, definitions, principles and statistics as the Secretary of Health and Human Services may prescribe in order to reach a uniform reconciliation of financial and statistical data for specified uniform reports to the Secretary of Health and Human Services.

(b) First, hospitals must follow a set of uniform reporting policies and practices as specified in Part 442 of this Article. Items such as methods of capitalization and depreciation of assets and direct charging of medical supplies and payroll-related employee benefits to using centers are examples of important policies which must be followed for reporting purposes. When these policies differ from those of the hospital, reconciliations must be made to reflect the required policies in completing the uniform financial report.

(c) Secondly, the principles and concepts utilized in the preparation of the uniform financial report will be based upon a portrayal of the hospital's activities on a functional basis regardless of third-party reimbursement policies. The uniform financial report described in this Manual has been designed to flow directly into the Federal cost reports required for Titles 18 and 19 where the functional trial balance of expenses is subject to grouping, reclassification and adjustment as the data moves to the reimbursement worksheets.

(d) The third key principle affecting the preparation of the uniform financial report is the requirement that costs will be measured at a level where uniformity can be obtained and a standard output measurement applied. For purposes of reporting, it was determined that standard units of measure would be applied to cost centers. Therefore, for uniform functional reporting of revenue and expense there may be a need for reclassification to convert revenue or costs from the responsibility reporting format to a functional reporting format.

(e) Responsibility reporting is defined as the reporting of costs according to organizational units such as departments.

(f) Functional reporting is defined as the reporting of costs according to type of activity.

(g) Total costs are the same with either functional or responsibility reporting. However, because organization structures vary among hospitals, responsibility reporting does not allow the comparability necessary for reasonable evaluation. Therefore, the reporting system for hospitals was developed to allow comparable reporting of hospital costs while hospitals maintain responsibility accounting systems if they so desire.

(h) Hospitals are required to report:

(1) hospital profile data--data identifying the control, type, services offered, certification(s) , programs, coverage, etc. of the facility;

(2) assets, liabilities and equity--all balance sheet accounts whose titles are capitalized in the listing of accounts and whose numerical code ends in "0" when such assets, liabilities and equity exist (and certain subaccounts as noted in section 446.8 of this Part);

(3) daily hospital services--all revenue and expense centers whose titles are capitalized in the listing of accounts and whose numerical code ends in "0" when such revenue centers and cost centers exist and are located in a discrete unit of the facility (and certain subaccounts as noted in section 446.9 of this Part). A discrete unit is a separately organized, staffed and equipped unit of the facility;

(4) where two or more daily hospital services, as defined in Part 444 of this Article, are provided in the same unit, the revenue and expense applicable to that unit must be reported in the functional revenue and cost centers which best describe the principal patient service provided in the combined unit. For example, assume that a hospital maintains a combined acute care unit which provides medical/surgical, pediatric and obstetrics acute care. Also assume that principal patient care service provided in this unit is medical/surgical acute care. The hospital in this situation will report the revenue and expense applicable to this unit as being medical/surgical acute care. Furthermore, the hospital, when completing the Services Inventory Worksheet, will indicate that Pediatric Acute Care and Obstetrics Acute Care are being reported as medical/surgical acute care in the reporting forms by entering the Medical/Surgical Acute account number;

(5) all other revenue centers and cost centers--all other revenue centers and cost centers whose titles are capitalized in the listing of accounts and whose numerical code ends in "0" when the services or function exists or is performed in the hospital, irrespective of whether or not it is a discrete unit (and certain subaccounts as noted in section 446.9 of this Part); (6) units of measure--the required standard unit of measure must be accumulated and reported for all expense centers indicated in Part 444 of this Article;

(7) natural classification of expense--all natural classifications of expense, except salaries and wages, whose numerical code ends in 0". All of the salaries and wages sub-natural classifications e.g., .01 Management and Supervision, .02 Technician and Specialist, .03 Registered Nurse, etc.) must be reported for each functional cost center, as appropriate;

(8) other supplemental reimbursement reporting--for other third-party reimbursement as described in sections 446.7 through 446.44 of this Part.

(i) All data reported must be presented in accordance with the listing of accounts and definitions, identified in other parts of this Manual. No line or column description may be changed under any circumstances, unless an exception has been granted. For Medicare purposes only, substitute cost reporting forms may be used. All substitute cost reporting forms must be identical in all respects to the Health Care Financing Administration (HCFA) forms, including designation by some distinctive symbol or character of those areas which are shaded on the official HCFA forms. Substitute cost reporting forms may be accepted for use in lieu of the official HCFA forms, subject to review and acceptance by HCFA. HCFA will also accept the report in machine-readable media subject to the specifications to be prescribed by HCFA at a later date.
 

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Section 446.2 - Reclassification for reporting purposes

446.2 Reclassification for reporting purposes. (a) Reclassifications are necessary to adjust the financial data contained in the hospital's records to the reporting requirements in this Article where they are not recorded on a functional basis. The reclassifications must be completed prior to preparing the required reporting forms and must be maintained as part of the hospital's books and records.

(b) There are two types of reclassifications:

(1) reclassifications to obtain the required level of reporting; and

(2) reclassifications to correct accumulation of costs and revenues.

(c) The first type of reclassification may be necessary to reach the required level of reporting because the hospital has combined several cost or revenue centers. For instance, a hospital may be combining the costs of diagnostic radiology with therapeutic radiology. In such cases, it is necessary to reclassify the total direct costs by natural classification of expense incurred for the two different types of services into two specific cost centers relating to these two types of services.

(d) The second type of reclassification, to correct the accumulation of costs and revenues, would be necessary when the expense and/or revenue associated with a particular function is recorded in a cost center different from the functional description specified in this Manual. For instance, a reclassification would be required if the Surgery Services cost/revenue center included the costs and revenues associated with the sale of prostheses and appliances because these costs and revenues must be reported in the Medical Supplies Sold cost/revenue centers rather than the Surgery Services cost/revenue centers.

(e) If expenses and revenues related to the functions as defined by this Manual have not been included in the direct costs or revenues of the indicated cost center, a reclassification is required, if significant. In no instance shall an amount be considered insignificant if, in any year for any cost center, the aggregate amount of misplaced costs or revenues is equivalent to 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) These reclassifications may be computed on any one of the following bases:

(1) analysis of direct expense, including time and cost studies;

(2) ratio of total charges to charges of a specific cost center; or

(3) ratio of total units of service to units of service being reclassified in a specific cost center.

(h) Activities common to most functional reporting centers, such as planning, appraising, analyzing, preparing staffing schedules, meeting legal requirements and sanitary standards, keeping abreast of applicable fields, clerical work incidental to the activities of the functional reporting center, documenting work performed, initiating requisitions, the provision for and receipt of in-service education, educating patients for self-care, maintaining specialized libraries, preparing budgets, evaluating assigned personnel and attending meetings, shall be assigned to the functional reporting center in which the activity is performed. The operation of equipment includes preventive maintenance such as cleaning, oiling and calibration.

(i) Other activities are unique (as herein defined) and their cost must be reported per the cost center functional descriptions. If the cost of these activities are accumulated in a different cost center, they must be reclassified. To assist in the identification of these, a sample list of functions whose costs must occasionally be reclassified is included in the following Functional Reclassification Matrix along with the centers to which they must be reclassified if they are significant.
 

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Section 446.3 - Reclassification for cost finding purposes

446.3 Reclassification for cost finding purposes. (a) Reclassifications for Medicaid cost finding purposes.

(1) In many instances the reclassifications made to conform to the principles of functional reporting (see section 446.2 of this Part) are not conducive to the proper allocation of cost during the cost finding process. For example, nonroutine maintenance must be assigned to the Plant Maintenance (account 8400) cost center to accomplish the functional reporting of expense. The basis to be used for cost finding is Net Square Feet. If the cost of nonroutine maintenance is allocated on the basis of Net Square Feet, the resulting distribution of this expense would include cost centers for which no nonroutine maintenance was performed. A better allocation of the cost of nonroutine maintenance would be accomplished by reclassifying this cost out of the functional cost center to the cost centers for which nonroutine maintenance was performed, prior to utilizing Net Square Feet to allocate the remaining cost to the other appropriate functional cost centers.

(2) Therefore, reclassifications of the direct expenses of functional cost centers may be made to other functional cost centers for cost finding purposes when that direct expense is obtainable. Estimates, time studies, sampling or other means may not be used as a basis for reclassification. The required Cost Allocation statistics must be used to allocate costs remaining in the functional cost centers after reclassifications are made.

(b) Reclassifications for Medicare cost finding purposes. (1) Other Health Profession Education (account 8260). This expense account consists of the direct costs of organized educational programs such as school of medical technology, school of X-ray technology, administrative intern program, etc. The total direct expenses included in Other Health Profession Education must be reclassified to the costs centers directly affected by the educational programs; for example, the cost of the school of X-ray technology must be reclassified to the appropriate radiology cost centers.

(2) Medical Care Review (account 8740). This expense account consists of the costs incurred in providing peer review, quality assurance, utilization review, professional standards review, and medical care evaluation functions. Only utilization review costs of the hospital-based skilled nursing facility should be reclassified as follows: If the scope of the review covers all patients, all allowable costs should be reclassified in this column to Other Administrative and General. If the scope of the review covers only Medicare patients or Medicare title V and title XIX patients, reclassify to Other Administrative and General all allowable costs other than physicians' compensation. The reasonable compensation paid to the physicians for their services on utilization review committee is to be allocated 100 percent to the health care programs. The reasonable compensation paid to the physicians will be adjusted out by the Worksheet--Adjustment Prior to Cost Finding, and will be included on the Worksheet--Computation of Net Cost of Covered Services.

(3) Insurance--Hospital and Professional Malpractice (account 8840). This expense account consists of the direct costs incurred by the provider for hospital and professional malpractice insurance. This provides for reclassifying the general and administrative expense directly related to malpractice losses. All allowable and non-allowable uninsured malpractice losses and related expenses, either through deductible or coinsurance provision, or as a result of an award in excess of reasonable coverage limits, or as a governmental provider, must be reclassified to the malpractice insurance account.

(4) Insurance--Other (account 8850). This expense account consists of expenses incurred in maintaining insurance policies, except for professional and hospital malpractice insurance and employee benefit insurance. Insurance cost applicable to fixed assets and movable equipment must be reclassified to the applicable cost center. Any insurance expense which cannot be identified to a specific cost center will be reclassified to Administrative and General.

(5) Licenses and Taxes (other than income taxes) (account 8860). This expense account consists of the business license expense and tax expense incidental to the operation of the hospital. Licenses and taxes (other than income taxes) applicable to fixed assets and movable equipment must be reclassified to the applicable cost center. Any licenses and taxes which cannot be identified to a specific cost center and are related to the general overall operation of the hospital must be reclassified to the Administrative and General account.

(6) Interest Short-Term (account 8870). This expense account consists of interest expense related to borrowings for hospital operations. The full amount of cost must be reclassified to Administrative and General. (7) Interest Long-Term (account 8880). This expense account consists of all interest incurred on capital, mortgages and other loans for the acquisition of property, plant and equipment. Interest on Mortgage Loans will be reclassified to Depreciation, Amortization, Fixed Assets. Interest on Movable Equipment will be reclassified to Depreciation, Amortization, Movable Equipment.
 

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Section 446.4 - Alternative cost allocation bases--sequence of allocation

446.4 Alternative cost allocation bases--sequence of allocation. (a) Effective dates.

(1) For cost reporting periods ending December 31, 1981 and before, alternative cost allocation bases/sequence of allocation may be utilized without the prior approval of the Medicare fiscal intermediary. When utilizing an alternative cost allocation base or sequence of allocation, full documentation as to the necessity, appropriateness, and methodology utilized must be provided. The criteria in subdivision (d) of this section must be met. This requirement applies to all third-party payors.

(2) For cost reporting periods beginning on January 1, 1982 and thereafter, when a hospital wishes to change its allocation basis for a particular cost center or the order in which the cost centers are allocated, because it believes the change will result in more appropriate and more accurate allocations, the hospital must make a written request to its Medicare fiscal intermediary for approval of the change and submit reasonable justification for such change no later than 90 days prior to the beginning of the cost reporting period for which the change is to apply. This requirement will apply to all cost-finding methods and all third-party payors.

(b) The Medicare fiscal intermediary's approval of a hospital's request will be furnished to the hospital in writing. Where the Medicare fiscal intermediary approves the hospital's request for an alternative basis or sequence of allocation, the change must be applied to the cost reporting period for which the request was made and to all subsequent cost reporting periods unless the intermediary approves a subsequent request for change by the hospital. The effective date of any change of basis or sequence of allocation will be the beginning of the first cost reporting period for which the request has been made.

(c) In reviewing the hospital's request, the Medicare fiscal intermediary will apply the following criteria:

(1) Basis of allocation. (i) The hospital must agree to maintain and report all statistics needed for the recommended basis of allocation as well as the alternative basis of allocation. The hospital will report the recommended basis on an additional completed Worksheet, prominently marked at the top "Original Recommended Basis". For New York State reporting purposes, this requirement is effective for cost reporting periods beginning in 1980. For Medicare reporting purposes, this requirement is effective for cost reporting periods beginning in 1981.

(ii) Any alternative basis of allocation expressed solely in terms of percentages will be not acceptable.

(iii) Any alternative basis of allocation must be supported by auditable statistics that are maintained on a regular basis.

(iv) The alternative basis of allocation must directly relate to the provision of services by the affected cost center.

(v) The alternative basis of allocation must produce a clearly more accurate allocation of cost than the recommended basis of cost. For example, the recommended basis of allocation for cafeteria costs is full-time equivalent employees. If the provider chooses to maintain an alternative basis of allocation of sales value of meals served to employees by functional cost center, a more accurate allocation would result. Alternatively, the recommended basis of allocation for laundry is pounds of laundry; however, the use of the number of items issued would not result in a more accurate allocation of costs.

(vi) Only one statistical basis of allocation may be used for each cost center.

(2) Sequence of allocation. The sequence of allocation of step-down cost finding is based upon the assumption that a cost center furnishes more services to the cost centers that follow it in the sequence of allocation than it receives from the cost centers that precede it in the sequence of allocation, and that a cost center receives more services from the cost centers that precede it in the sequence of allocation than it furnishes to the cost centers that follow it in the sequence of allocation. In order to justify the use of an alternative sequence of allocation, a provider must establish through auditable records that the dollar value of goods and services exchanged among cost centers is different than that contemplated in the sequence recommended in the cost reporting forms.

(d) Alternative cost allocation bases or the sequence of allocation, utilized in accordance with this section, must be utilized across all third-party payors.
 

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Section 446.5 - Recommended cost allocation bases--listing

446.5 Recommended cost allocation bases--listing. (a) Cost allocation utilizes statistics to make the distribution of the costs of nonrevenue producing cost centers to each other and to revenue producing cost centers. The purpose of cost allocation is to determine the total or full costs of operating the revenue producing centers of the hospital.
(b) The recommended statistical bases for cost allocation are listed below for each cost center. It is advisable to develop a written procedure for the collection of these statistical data to meet the reporting requirements. The definitions and sources of the recommended statistics for cost allocations are provided in section 446.6 of this Part.
Functional Account Basis of Allocation
Cost Center Number Medicaid Medicare

(1) DAILY HOSPITAL SERVICES

(i) Acute Care:

Medical/Surgical 6010 None None

Pediatric 6170 None None

Psychiatric 6210 None None

Obstetrics 6250 None None

Definitive Observation 6280 None None

Other Acute Care 6290 None None

(ii) Intensive Care Services:

Medical/Surgical 6310 None None

Coronary 6330 None None

Pediatric 6350 None None

Neo-Natal 6370 None None

Burn 6380 None None

Psychiatric 6390 None None

Other Intensive Care I 6410 None None

Other Intensive Care II 6420 None None

Other Intensive Care III 6430 None None

(iii) Nursery Services:

Newborn Nursery 6510 None None

Premature Nursery 6520 None None

(iv) Sub-Acute Care Services:

Skilled Nursing Care--

Medicare/Medicaid Certified 6610 None None

Medicaid Certified 6620 None None

Psychiatric Long-Term Care 6630 None None

Tuberculosis Long-Term Care 6640 None None

Intermediate Care--

Mentally Retarded 6650 None None

Other 6660 None None

Residential Care 6670 None None

Other Sub-Acute Care 6680 None None

Other Sub-Acute Care Hospit al

Services 6680 None None

Other Sub-Acute Care Non-Hospital

Services 6690 None None

(2) AMBULATORY SERVICES

Emergency Services 6710 None None

Clinic Services 6720 None None

Home Program Dialysis:

Equipment--100% 6810 None None

Equipment--Other 6820 None None

Ambulatory Surgery 6830 None None

Psychiatric Day/Night 6840 None None

Ambulance Services 6850 None None

Other Ambulatory Services 6860 None None

Free Standing Clinic:

Free Standing Clinic I 6870 None None

Free Standing Clinic II 6880 None None

Free Standing Clinic III 6890 None None

Home Health Services:

Skilled Nursing Care 6910 None None

Medical Social Services 6920 None None

Home Health Aides 6930 None None

Other Home Health 6990 None None

(3) ANCILLARY SERVICES

(i) Labor and Delivery

Services:

Labor and Delivery 7010 No. of Procedures Ratio of Cost to
Charges Applied
to Charges
(RCCAC)

(ii) Surgical Services Group:

Surgery Services 7040 No. of Surgery RCCAC
Minutes

Recovery Services 7060 No. of Recovery RCCAC
Minutes

Anesthesiology 7080 No. of Anesthesia RCCAC
Minutes

(iii) Medical Supplies
and Equipment Group:

Medical Supplies Sold 7110 Dept. Charges RCCAC

Durable Medical
Equipment--Sold 7130 Dept. Charges RCCAC

Leased/Rented 7140 Dept. Charges RCCAC

(iv) Drugs Sold:

Drugs Sold: 7150 Dept. Charges RCCAC

(v) Laboratory Services

Group:

Laboratory Services:

Clinical Services 7210 C.A.P. Workload RCCAC

Pathological Services 7230 C.A.P. Workload RCCAC
Whole Blood & Packed 7250 C.A.P. Workload RCCAC
Red Cells

Blood Storing 7260 C.A.P. Workload RCCAC
& Processing

(vi) Electrocardiology:

Electrocardiology 7290 C.A.P. Workload RCCAC

(vii) Cardiac Catherization:

Cardiac Catherization Lab 7310 Dept. Charges RCCAC

(viii) Radiology Services
Group:

Radiology-Diagnostic 7320 California R.V.U. RCCAC

CT Scanner 7340 No. of Procedures RCCAC

Radiology-Therapeutic 7360 California R.V.U. RCCAC

Nuclear Medicine 7380 California R.V.U. RCCAC

(ix) Respiratory Therapy:

Respiratory Therapy 7420 Dept. Charges RCCAC

(x) Pulmonary Function:

Pulmonary Function 7440 California R.V.U. RCCAC
Testing

(xi) Neurology-Diagnostic:

Neurology-Diagnostic 7460 California R.V.U. RCCAC

(xii) Therapy Services Group:

Physical Therapy 7510 Dept. Charges RCCAC

Occupational Therapy 7530 Dept. Charges RCCAC

Speech/Language Pathology 7550 Dept. Charges RCCAC

Recreational Therapy 7570 Assigned Time RCCAC

Audiology 7580 Dept. Charges RCCAC

Other Physical Medicine 7590 No. Of Treatments RCCAC

Psychiatric/Psychological 7670 Dept. Charges RCCAC

(xiii) Renal Dialysis:

Renal Dialysis 7710 No. of Treatments RCCAC

(xiv) Organ Acquisition and

Other:

Kidney Acquisition 7730 None RCCAC

Other Organs Acquired 7750 None RCCAC

Other Ancillary Services 7910 Specify RCCAC

(4) OTHER OPERATING EXPENSES

(i) Research Expenses:

Research 8010 None None

(ii) Education Expenses:

Nursing Education 8220 Assigned Time of Assigned Time of
Nursing Students Nursing Students

Post Graduate Medical Education

Primary Care Teaching Programs

Approved-Internal 8240 Assigned Time of To be Determined
Medicine Students

Approved-Family Practice 8250 Assigned Time of To be Determined

Students

Approved-Pediatrics 8260 Assigned Time of To be Determined

Post Graduate Medical Education Students

Other Approved Teaching 8270 Assigned Time of Assigned Time of

Program Students Students

Post Graduate Medical Education

Non-Approved Teaching 8280 Assigned Time of None

Students

Other Health Professional 8290 Assigned Time of None

Education Students

(iii) General Services:
Dietary Services 8310 Patient Meals Served Meals Served

Non-Patient Food Service 8320 Adjusted F.T.E. F.T.E. Employees
Employees

Laundry and Linen 8330 Pounds Distributed Pounds of Laundry

Social Work Services 8360 Time Spent Daily Hospital and

Ambulatory Services

Gross Patient

Revenue

Housing 8360 Rooms Occupied by Number Housed

Department

Plant Operations and 8410 Net Square Feet Square Feet

Maintenance

Plant Maintenance 8400 Net Square Feet Square Feet

Maintained

Plant Operation 8410 Net Square Feet Square Feet

Security 8430 Net Square Feet Square Feet

Parking 8440 Net Square Feet Square Feet

Housekeeping 8450 Assigned Time Hours of Service

Central Services and 8460 Central Services Central Services

Supplies Cost Requisitions Costed Requisitions

and Cost of Sales and Cost of Sales

Pharmacy 8470 Pharmacy Costed Pharmacy Costed

Requisitions and Requisitions and

Cost of Sales Cost of Sales

(iv) Fiscal Sevices:

General Accounting 8510 Accumulated Cost Direct Cost

Patient Accounts, Admitting

and Registration 8520 Accumulated Cost Gross Patient

Charges

Admitting 8530 Accumulated Cost To be Determined

Registration 8540 Accumulated Cost To be Determined

(v) Administrative Services:

Hospital Administration 8610 Accumulated Cost Direct Cost

Purchasing and Stores 8690 Direct Cost of Direct Cost of

Supplies Expensed Supplies Expensed

Medical Records 8710 Hours of Service Gross Patient

Charges

Medical Staff 8720 Percent of Effort Direct Cost

Administration

Medical Staff Services 8730 Professional Compo- None
nent by Cost Center

Medical Care Review 8740 Number of Inpatient None

Discharges (exclude

Newborn)

Nursing Administration 8750 Hours of Total Assigned Time

Direct Nursing

Service

Medical Photography and

Illustration 8760 Time Spent Direct Cost

Fund Raising 8780 None None

(vi) Unassigned Expenses:

Depreciation and 8810 Dollars of Square Feet

Amortization- Depreciation

Fixed Assets

Leases and Rentals- 8815 Dollars of Square Feet

Fixed Assets Lease/Rent

Depreciation and Amortization

Movable Equipment 8820 Dollars of Square Feet or

Depreciation Dollar Value

Leases and Rentals

Movable Equipment 8823 Dollars of Square Feet or

Lease/Rent Dollar Value

Benefits-Non-Payroll

Related 8830 F.T.E. Employees F.T.E. Employees

Insurance-Hospital and

Professional

Malpractice 8840 Accumulated Cost None

Insurance-Other 8850 Accumulated Cost None

Licenses and Taxes (Other

than Income Taxes) 8860 Accumulated Cost None

Interest-Short-Term 8870 Accumulated Cost None

Interest-Long-Term 8880 Dollars of Interest None
 

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Section 446.6 - Definitions and sources of statistics for Medicaid cost allocation

446.6 Definitions and sources of statistics for Medicaid cost allocation.

Statistic Definition or Method of Computation Source

(a) OTHER OPERATING EXPENSES

(1) Assigned Time- Number of hours worked by Education curriculum Nursing enrolled nursing students and work records Education (RN or LPN) by assigned program service area.

(2) Assigned Time- Number of hours worked on Education curriculum Post Grad. Med. premises by interns and residents and work records Ed. (Approved in the approved postgraduate Program) medical education programs by assigned cost center. Outside time is excluded.

(3) Assigned Time- Number of hours worked on Education curriculum Post Grad. Med. premises by interns and residents and work records Ed. (Non- in the non-approved postgraduate Approved Prog.) medical education programs by assigned cost center. Outside time is excluded.

(4) Time spent- Number of hours utilized by social Departmental Social Work workers handling specific patient's records or Time Services needs, by program service area to Study which the patients are assigned. Time spent not related to a specific patient is not to be counted.

(5) Number of The average number of rooms rent- Personnel and rooms Occu- ed to hospital employees, non-paid General pied by Dept. workers and students participating Accounting records Assigned- in education programs carried on by Housing the hospital by department to which the personnel are assigned. Exclude common areas (i.e., recreation room) in the room count. A monthly census as of the last day of every month must be taken and averaged for the year.

(6) Net Square For each cost center for which Blueprints of Feet Maintained- maintenance is provided, allocate the Hospital Plant based upon the total net square plant or actual Maintenance feet of the cost center maintained. measurement if Net square feet is defined as: blueprints are The interior square feet in each not available functional cost center of the hospital measurement of the hospital or a determined by either a physical measurement from blueprints. Floor area measurements must be taken from the center of interior walls to the center of adjoining corridors, if such corridors service more than one cost center. Exclude stairwells, elevators, and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc., serving only one cost center must be included in that cost center. When changes in area have been made during the year as a result of new construction, cost center relocation, expansion or contraction, statistical data must be maintained to allow for the development of "weighted" areas for the fractional part of the year. For example, the addition or deletion of 1200 square feet for a six-month period would be an adjustment of 800 square feet; where the same area serves more than one functional cost center, this area must be apportioned between or among the appropriate functions.

(7) Net Square Net square feet by department is Blueprints of Feet-Plant defined as follows: The interior the Hospital Operation, square feet in each functional cost plant or actual Energy, center of the hospital determined measurement if Security, and by either a physical measurement blueprints are not Parking, Plant of the hospital or a measurement available Operation & from blueprints. Floor area Maintenance measurements must be taken from the center of interior walls to the center of adjoining corridors, if such corridors service more than one cost center. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc., serving only one cost center must be included in that cost center. When changes in area have been made during the year as a result of new construction, cost center relocation, expansion or contraction, statistical data must be maintained to allow for the development of "weighted" areas for the fractional al part of the year. For example, the addition or deletion of 1200 square feet for a six-month period would be an adjustment of 800 square feet; where the same area serves more than one functional cost center, this area must be apportioned between or among the appropriate functions. (8) Assigned Time- Scheduled housekeeping hours of Housekeeping Housekeeping service to be spent in maintaining Cost Center cleanliness and sanitation of each records functional cost center. Hours to be spent cleaning general and unused areas must be excluded.

(9) Assigned Time- Number of hours worked on prem- Education Other Health ises by health profession student, curriculum and Professional Ed. excluding RN, LV(P)N, intern and work records resident students, by assigned cost centers.

(10) Patient meals Number of patient meals Actual count Served- served shall include only regular maintained by Dietary scheduled meals and exclude Dietary Services Services snacks and fruit juices served cost center between regular scheduled meals.

(11) Adjusted Divide the total annual paid Payroll or F.T.E. Employees- hours (including vacation, sick Personnel Non-Patient leave and overtime) for all those Records Food Service employees for whom the cafeteria is available for use by cost center by 40 hours; divide the result by 52. If employees are paid for unused sick leave, exclude the hours so paid from the calculation. Please round to nearest tenth of an F.T.E. only.

(12) Dry and Clean The weight of linen processed plus Actual count Pounds the equivalent weight of disposable maintained by Distributed- linen substitutes used. Include the Laundry and Laundry and uniforms and linen from Personnel Linen Dept. Linen 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.

(13) Costed requis- Central Services Costed requisi- Copies of cost itions and Cost tions means: Total dollar amount center of Sales- (based on invoice cost) of non- requisitions Central chargeable supplies transferred or other Services and from the central services and documentation Supply supplies cost center to each using cost center. Central Services Cost of Sales means: The invoice cost of all supplies sold to patients and others regardless of the issuing cost center.

(14) Costed Pharmacy costed requisitions Copies of cost Requisitions means: Total dollar amount (based center requi ad Cost of on invoice cost) of nonchargeable sitions or other Sales- pharmaceutical items transferred documentation Pharmacy from the Pharmacy Cost Center to each using cost center Pharmacy Cost of Sales means: The invoice cost of all pharmaceutical items sold to patients and others regardless of issuing cost center.

(15) Accumulated To be generated through computer Not Applicable Cost-General software. Nothing is to be reported. Accounting; Patient Accounting; Admitting and Registration; Hospital Administration; Insurance Malpractice; Insurance Other; Licenses and Taxes; Interest Short-Term

(16) Direct Total direct cost of medical General Accounting cost of and surgical supplies (natural records Supplies classification .40) and non-medical Expensed- and non-surgical supplies Purchasing and (natural classification .50) by cost Stores center, as reclassified, excluding pharmacy (accounts 8470 and 7150), patient dietary service (account 8310), and non-patient food services (account 8320).

(17) Hours of Accumulated hours of service Departmental records Service- to program service centers. or Time Study Medical If this is unavailable, a Records questionnaire time survey may be used.

(18) Percent of Percent of time spent by the Time Study Effort- Chief of Medical Staff in the Medical Staff ancillary or program service areas Administration for which he has responsibility.

(19) Professional Using the calculations made to General Accounting Component by generate the reclassification records Cost Center necessary to create this cost Assigned- center, distribute costs back to the Medical Staff appropriate ancillary or program Services service area from which the physician cost arose (i.e., Radiology, Laboratory, Emergency Room, etc.).

(20) Number of The number of patients discharged Medical Records or Discharges- from the Hospital accumulated by statistical reports Medical Care program service centers, excluding Review routine newborn.

(21) Hours of Actual hours worked of nurses Personnel, Payroll Total Direct for which administration is or Departmental Nursing Service- provided by assigned area. records Nursing Administration (22) Dollars of The depreciation expense related to General Accounting Depreciation/ each building (or wing) distributed records and blue Amortization by through square feet to departments prints of the Cost Center- in that building (or wing) (result- Hospital plant Depreciation & ing statistic reported as a weighted or actual Amortization statistic, dollars of depreciation). measurement of (Fixed Assets). The square feet used to distribute blueprints are Refer to sub- the expense is Net Square Feet by not available division (c) of building (or wing) defined as this section follows: The interior square feet for an example. in each functional cost center of the hospital determined by either a physical measurement of the hospital or a measurement from blueprints. Floor area measurements must be taken from the center of interior walls to the center of adjoining corridors, if such corridors service more than one cost center. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc. serving only one cost center must be included in that cost center. When changes in area have been made during the year as a result of new construction, cost center relocation, expansion or contraction, statistical data must be maintained to allow for the development of "weighted' areas for the fractional part of the year. For example, the addition or deletion of 1200 square feet for a six-month period would be an adjustment of 600 square feet; where the same area serves more than one functional cost center, this area must be apportioned between or among the appropriate functions.

(23) Dollars of The lease and rental expense General Accounting Lease/Rent by related to each building (or records and blue Cost Center- wing) distributed through square prints of the Leases and feet to departments in that building Hospital plant Rentals (or wing) (resulting statistic or actual (Fixed Assets). reported is a weighted statistic, measurement if Refer to sub- dollars of rentals and leases). blueprints are division (c) of The square feet used to allocate not available this section the expense is Net Square Feet by for an example. building (or wing) defined as follows: The interior square feet in each functional cost center of the hospital determined by either a physical measurement of the hospital or a measurement from blueprints. Floor area measurements must be taken from the center of interior walls to the center of adjoining corridors, if such corridors service more than one cost center. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc., serving only one cost center must be included in that cost center. When changes in area have been made during the year as a result of new construction, cost center relocation, expansion or contraction, statistical data must be maintained to allow for the development of "weighted" areas for the fractional part of the year. For example, the addition or deletion of 1200 square feet for a six-month period would be an adjustment of 800 square feet; where the same area serves more than one functional cost center, this area must be apportioned between or among the appropriate functions.

(24) Dollars of The cost of depreciation on Plant LedgerDepreci ation by movable equipment must be records Cost Center- allocated to the functional cost Depreciation & center utilizing that equipment. Amortization- Where the cost center of Movable depreciation on movable equipment Equipment. is utilized by two or more Refer to sub- functional cost centers, the division (c) of depreciation mustbe allocated this section between the costcenters based upon for an example. cost center usage. (25) Dollars of The cost of leases/rentals on General Accounting Lease/Rent by movable equipment must be records and Lease/ Cost Center- allocated to the functional cost Rent Agreements Leases and center utilizing the equipment. Rentals- Where the cost of leases/rentals Movable on movable equipment is utilized Equipment. by two or more functional cost Refer to sub- centers, the lease/rent must be division (c) of allocated between the cost centers this section based upon cost center usage. for an example.

(26) F.T.E. Divide the total annual paid hours Payroll or Employees- (including vacation, sick leave Personnel Employee and overtime) for all employees by records Benefits- cost center by 40 hours; divide Non-Payroll- the result by 52. If employees are Related paid for unused sick leave, exclude the hours so paid from the calculation. Please round to nearest tenth of an F.T.E. only.

(27) Dollars of The interest expense related to General Accounting Interest by capital debt will be allocated records and Cost Center- through square feet to departments blue-prints of Interest- in the building (or wing) for which the Hospital Long-term. the debt was incurred (weighted plant or actual Refer to sub- statistic, dollars of interest). measurement if division (c) of The square feet used to allocate blueprints arethis section the expense is Net Square Feet by not available for an example. building (or wing) defined as follows: The interior square feet in each functional cost center of the hospital determined by either a physical measurement of the hospital or a measurement from blueprints. Floor area measurements must be taken from the center of interior walls to the center of adjoining corridors, if such corridors service more than one cost center. Exclude stairwells, elevators and other shafts. General and unused areas are also to be excluded. Hallways, waiting rooms, storage areas, etc. serving only one cost center must be included in that cost center. When changes in area have been made during the year as a result of new construction, cost center relocation, expansion or contraction, statistical data must be maintained to allow for the development of "weighted" areas for the fractional part of the year. For example, the addition or deletion of 1200 square feet for a six-month period would be an adjustment of 600 square feet; where the same area serves more than one functional cost center, this area must be apportioned between or among the appropriate functions.

(28) Time Spent-- The number of hours utilized by Departmental Medical Photog- another functional cost center records or raphy and of personnel in the Medical Photog- Time Study Illustration raphy and Illustration cost center.

(b) ANCILLARY SERVICES

(1) Number of Refer to the definition of the Departmental Procedures-- Standard Unit of Measure in records or Labor and section 444.20(a) of this Article. Statistical Delivery Report this statistic by the reports Services required program service areas.

(2) Surgery Refer to the definition of the Departmental Minutes-- Standard Unit of Measure in records or Surgery section 444.20(b)(1) of this Article. Statistical Services Report this statistic by the reports required program service areas.

(3) Recovery Refer to the definition of the Departmental Minutes-- Standard Unit of Measure in records or Recovery section 444.20(b)(2) of this Article. Statistical Services Report this statistic by the reports required program service areas.

(4) Anesthesia Refer to the definition of the Departmental Minutes-- Standard Unit of Measure in records or Anesthesiology section 444.20(b)(3) of this Article. Statistical Report this statistic by the reports required program service areas.

(5) Departmental Report gross charges for the speci- General Gross Charges-- fic department by the required pro- accounting Medical Supplies gram service areas. All-inclusive records Sold; Durable rate hospitals have the option of Medical Equip- using the Standard Units of measure ment--Sold; for the applicable functional Durable Medical cost center reported by the required Equipment-- program service areas in lieu of Leased/Rented; Departmental Gross Charges, if Drugs Sold; charges are not available. Cardiac Catheterization Laboratory; Respiratory Therapy; Speech/Language Pathology Audiology; Psychiatric/ Psychological Services (6) C.A.P Work- Most recent College of American Departmental load--Laboratory Pathologists Workload Measure- records or Services--Clinical; ment Unit Manual. Refer to sub- Statistical Laboratory Ser- divisions (e), (f) and (j) of reports vices--Patholo- section 444.20 of this Article gical; Whole Blood for a further definition of the and Packed Red Standard Unit of Measure. Report Cells; Electro- this statistic by the required cardiology; Pul- program service areas. monary Function Testing

(7) California California Medical Association, 1974 Departmental R.V.U.--Radiology-- California Relative Value Studies. records or Diagnostic; Radio- Refer to the definitions of the Statistical logy--Therapeutic; Standard Units of Measure in section reports Nuclear Medicine; 444.20(h)(1), (h)(3), (h)(4) and (k) Neurology--Diag- of this Article. Report this statistic nostic by the required program service areas.

(8) Number of Pro- Refer to the definition of the Stand- Departmental cedures--C.T. ard Unit of Measure in section 444.20 records or Scanner (h)(2) of this Article. Report this Statistical statistic by the required program reports service areas.

(9) American Physi- Refer to the definition of the Stand- Departmental cal Therapy As- ard Unit of Measure in Section 444.20 records or sociation R.V.U.-- (l)(1) of this Article for Physical Statistical Physical Therapy Therapy (account 7530). Report this reports statistic by the required program service areas.

(10) American Occu- Refer to the definition of the Stand- Departmental pational Therapy ard Unit of Measure in section 444.20 records or Association R.V.U. (l)(2) of this Article for Occupa- Statistical --Occupational tional Therapy (account 7530). Re- reports Therapy port this statistic by the required program service areas.

(11) Assigned Time Number of Hours worked by Recrea- Departmental --Recreational tional Therapists with patients, by records Therapy program service to which patients are assigned.

(12) Number of Refer to the definition of the Stand- Departmental Treatments-- ard Unit of Measure in section 444.20 records or Other Physical (l)(6) of this Article. Report this Statistical Medicine Statistic by the required program reports service area.

(13) Number of Refer to the definition of the Stand- Departmental Treatments-- ard Unit of Measure in section 444.20 records or Renal Dialysis (m) of this Article. Report this Statistical statistic by the required program reports service area.

(14) Provider Spe- If a provider has a specific ancillary Departmental cify--Other service that they feel is not provided records or Ancillary for above, a complete description of Statistical Services that service along with a proposed reports Cost Allocation Statistic should be submitted to OHSM for prior approval (prior means six months before a fiscal year ends).

(c) EXAMPLE

(1) Wherever dollars are required as the Cost Allocation Base, the intent is to accomplish the allocation of the applicable mandatory zero-level account's cost through the direct expensing of that cost. For example, if the direct expense of Interest--Long-Term (account 8880) contains interest related to two long-term financing agreements, one related to the purchase of a C.T. Scanner and one related to a new addition, the method to be used in structuring the statistics--Dollars of Interest--is illustrated in the following paragraphs.

(2) Procedure outline. (i) Allocate interest on the new addition on the basis of Net Square Feet, within the new addition.

(ii) Allocate interest on the C.T. Scanner directly to the C.T. Scanner cost center (account 7340).

(iii) Combine the results of the above producing the statistic Dollars of Interest, as illustrated below.

(3) Calculations.

(1) (2) (1 + 2)

Interest Interest on Statistic

(i) Cost Center on addition C.T. Scanner Reported

Laboratory--

Clinical 15,000 -- 15,000

Pathological 20,000 -- 20,000

Dietary 10,000 -- 10,000

Nuclear Medicine 50,000 -- 50,000

C.T. Scanner 5,000 20,000 25,000

TOTAL 100,000 20,000 120,000

(ii) The interest on the addition is distributed on Net Square Feet in the addition, as follows:

Square Expense

Center Feet Percent Distribution

Laboratory-- Clinical 1,500 15 15,000

Pathological 2,000 20 20,000

1,000 10 10,000

Medicine 5,000 50 50,000

Scanner 500 5 5,000

10,000 100 100,000
 

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Section 446.7 - Description of other New York State supplemental data

446.7 Description of other New York State supplemental data. (a) Because of the data needs of the Office of Health Systems Management and other third-party payors, certain additional data must be reported for use in the health planning process, the rate appeal process, the trend factor determination process, the case mix analysis, the hospital grouping process, and/or to maintain comparability and continuity of data during the transition to functional reporting.

(b) Balance sheet reporting. (1) Please refer to section 446.8 of this Part, Balance Sheet Reporting, for a complete listing of all balance sheet items that must be reported. In each instance where additional reporting is required, it is shown as a further breakout from an existing mandatory zero-level account.

(2) Appropriate changes in the Statement of Changes in Fund Balance (for voluntary facilities), Reconciliation of Capital and Surplus (for proprietary facilities), and the Statement of Changes in Financial Position, will be made to reflect the reporting requirements.

(c) Other operating revenue reporting. (1) Additional breakouts in certain mandatory zero-level accounts will be required as follows:

(2) Account Description

(i) 5020 Transfers from Restricted Funds for Research Expenses Amounts transferred to cover overhead expenses must be reported separately from amounts transferred to cover direct expenses.

(ii) 5320 Cafeteria Sales. Employee Pay Cafeteria and Guest and Special Nurse's Meals must be reported separately.

(iii) 5870 Other Operating Revenue. Provision under this classification must be made for Supplies Sold to Patients, Nurse's Registry Fees, and Air Conditioning Rentals, as applicable.

(iv) 5880 Transfers from Restricted Funds for Other Operating Expenses. Provision must be made to report appropriations from special fund offset against expenses, not offset against expenses, and governmental grants. A detailed supporting document will also be required to indicate the sources of these funds.

(d) Deductions from revenue. (1) An additional breakout will be required in the following area:

(2) Account Description

5970 Administrative, Courtesy, and Policy Discounts and Adjustments. Employee discounts and adjustments must be reported separately from the remainder of this account.

(e) Nonoperating revenue and expense. (1) An additional breakout will be required in the following area:

(2) Account Description

9130 Retail Operations Revenue. Provision under this classification must be made for revenue from Public Restaurants, Gift Shops, and any other non-patient-related retail operation conducted by the hospital.

(f) Further breakdown of certain expenses. Certain expenses must be reported in more detail than provided for under functional reporting. Please refer to section 446.9 of this Part, Expense Detail Reporting, for a complete listing of all additional reporting of expenses. This reporting will be by Natural Classification of Expenses.

(g) Service contracts. If applicable, the provider must report the cost of services which are provided under contract by an outside organization, as opposed to being provided by salaried hospital staff. Each functional cost center affected must report its costs by Natural Classification.

(h) Imputed salaries. For nonpaid employees, the provider must report each employee's name, position, the functional cost center affected, the applicable subclassification of the Natural Classification .00 through .19 (Salaries), and the amount paid to that employee.

(i) Recoveries of expense. In accordance with current practice and Medicare/Medicaid regulations, recoveries necessary will be applied, either pre-stepdown or post-stepdown (as appropriate), to the applicable functional cost centers.

(j) Hospital personnel. The average number of full-time equivalent employees (calculated as defined in the Manual) and the standard number of hours in the working week (defined as the number of hours an employee works during the week, not necessarily the number of hours paid, (i.e., provider pays for 40 hours, employee works 37-1/2 hours with 1/2 hour paid lunch per day, report 37-1/2) must be reported by functional cost center. Reporting by salary subclassification (i.e., RN, Aides, Physicians, Clerical, etc.) is also required.

(k) Statistical/program supplemental data. In an effort to eliminate duplicative reporting requirements and to maintain all necessary data reported historically, an analysis of all previous sections of this Manual and the current reporting requirements was made. Please refer to sections 446.10 through 446.44 of this Part for a detailed outline of this supplemental data.

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Section 446.8 - Definitions and sources of statistics for Medicaid cost allocation

446.8 Balance sheet reporting.

CHART (refer to pages 4876.338 through 4876.342)
 

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Section 446.9 - Expense detail reporting

446.9 Expense detail reporting.

SHUR Account Number Functional account name/additional reporting

(a) 7150 DRUGS SOLD

(1) Pharmaceuticals

(2) All other

(b) 8310 DIETARY SERVICES

(1) Food

(2) All other

(c) 8320 NONPATIENT FOOD SERVICE

(1) Food

(2) All other

(d) 8400 PLANT MAINTENANCE

(1) Maintenance and Repairs

(2) Automotive Services

(3) Other (Specify)

(e) 8420 ENERGY

(1) Fuel Oil Number 2

(2) Fuel Oil Number 4

(3) Fuel Oil Number 6

(4) Natural Gas

(5) Purchased Steam

(6) Electricity

(7) Water

(8) Other (Specify)

(f) 8520 PATIENT ACCOUNTS, ADMITTING AND REGISTRATION

(1) Patient Accounting and Cashiers

(2) Admitting Office (Inpatient and Outpatient)

(3) Collection Fees

(g) 8610 HOSPITAL ADMINISTRATION

(1) Executive Office

(2) Telephone

(3) Postage

(4) Legal Fees

(5) Accounting Fees

(6) Public Relations

(7) Personnel Office

(8) Data Processing (provided to outside concerns only)

(h) 8810 DEPRECIATION AND AMORTIZATION--FIXED ASSETS

(1) Depreciation--Fixed Assets

(2) Amortization of Leasehold Improvements

(i) 8830 EMPLOYEE BENEFITS--NONPAYROLL-RELATED

(1) Employee Health Service

(2) Other (Specify)

(j) 8850 INSURANCE--OTHER

(1) General LiabIlity

(2) Umbrella (Excess Limits)

(3) Property

(k) 8860 LICENSES AND TAXES (OTHER THAN INCOME)

(1) Real Estate Taxes

(2) Other (Specify)

(l) 8993 EMPLOYEE BENEFITS--PAYROLL-RELATED

(1) Pension

(2) Old Age and Survivors Insurance

(3) Health Insurance

(4) Workers' Compensation Insurance

(5) Disability Insurance

(6) Unemployment Insurance

(7) Life Insurance

(8) Union Payments

(i) Pension

(ii) Health

(iii) Disability

(9) Other (Specify)

(10) Only the total amount of each item need be reported.

(m) 8621 DATA PROCESSING

A reconstitution and/or accumulation of the costs related to this function (prior to compliance with section 442.24(f) of this Article) must be reported.

(n) VARIOUS PHYSICIAN FEES

The Sub-Natural Classification .31-Physician, under Natural Classification. 30-Professional Fees, must be reported by the functional cost center to which the physician is assigned.
 

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Section 446.10 - Identification of supplemental data

446.10 Identification of supplemental data. The following sections contain an outline of all the reporting requirements not previously detailed in other sections of this Manual. Principally, this section contains the data requirements previously required by the Uniform Statistical Report, the Institutional Cost Report, and/or the Supplement to the Institutional Cost Report.
 

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STATISTICAL DATA

Section 446.11 - Service classification

STATISTICAL DATA

446.11 Service classification. (a) The following data is to be reported: (1) discharges;

(2) patient days (census); and

(3) certified bed capacity.

(b) Please refer to section 446.44(b) of this Part for all program services for which these statistics are to be reported.
 

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Section 446.12 - Accommodation classification

446.12 Accommodation classification. (a) Private rooms and two-or-more-bed rooms. The following data is to be reported:

(1) discharges

(2) patient days (census); and

(3) certified bed capacity.

(b) Please report these statistics for your total inpatient Daily Hospital Services, excluding:

(1) Nursery Services (accounts 6510 and 6520); and

(2) Sub-Acute Care Services (accounts 6610 through 6690).
 

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Section 446.13 - Visits

446.13 Visits. (a) Please report all visits in the following Ambulatory Care Service Areas:

(1) Emergency Services (account 6710)

(2) Clinic Services (account 6720)

(3) Home Program Dialysis Equipment--100% (account 6810)

(4) Home Program Dialysis Equipment--Other (account 6820)

(5) Ambulatory Surgery (account 6830)

(6) Psychiatric Day/Night (account 6840)

(7) Ambulance Services (account 6850)

(8) Other Ambulatory Services (account 6860)

(9) Free Standing Clinic (account 6870)

(10) Home Health Services

(i) Skilled Nursing Care (account 6810)

(ii) Medical Social Services (account 6820)

(iii) Home Health Aides (account 6830)

(iv) Other Home Health (account 6990)

(11) Kidney Dialysis (account 6860, 6720 or 7710, as appropriate)

(i) Renal Dialysis

(ii) Peritoneal Dialysis

(b) Discrete Medicaid rates for specialty clinics.

(1) Report these separately from the remainder of account 6720.

(2) Examples:

(i) MMTP Clinic;

(ii) Alcoholism Clinic;

(iii) Other (Specify).

(c) Program Service Areas to be reported:

(1) Total Inpatient Visits

(2) Outpatient Visits. Please refer to section 446.44(c) of this Part for all program services for which these statistics are to be reported.
 

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Section 446.14 - Changes in certified bed capacity

446.14 Changes in certified bed capacity. (a) As indicated on New York State Operating Certificate; the following data is to be reported:

(1) certified beds at the beginning of the reporting period;

(2) certified beds at the end of the reporting period;

(3) date the number of certified beds changed; and

(4) certified bed days available during the reporting period.

(b) Please refer to section 446.44 (b) of this Part for all program services for which these statistics are to be reported.
 

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BASIC INFORMATION

Section 446.15 - Governing authority

BASIC INFORMATION

446.15 Governing authority. (a) A listing of the members of the governing authority.

(b) Name and title of presiding officer of governing authority.

(c) Name and title of the chief executive officer.

(d) Specify type of organizational structure:

(1) Governmental.

(i) State.

(ii) Municipal.

(iii) Public corporation or authority.

(iv) Other (Specify).

(2) Voluntary.

(i) Type A.

(ii) Type B.

(iii) Type C.

(iv) Type D.

(v) Religious corporation.

(vi) Article IX-C corporation.

(vii) Other (Specify).

(3) Proprietary.

(i) Individual.

(ii) Partnership.

(iii) Corporate.

(e) Compensation:

(1) Amounts paid to officers, directors and trustees.

(2) Five highest paid employees earning in excess of $30,000 per year.

(3) If applicable, hospital must provide a copy of Schedule A of IRS Form 990.

(f) A listing of physicians and/or professional corporations providing medical services and receiving money payments from the hospital:

(1) Basic selection criteria:

(i) Governing authority approval.

(ii) Payments exceed 10 percent of the functional cost center's direct cost. (2) Information to be provided:

(i) Name of physician or professional corporation.

(ii) Number of individuals providing service to the hospital.

(iii) Amount of payments made by the hospital.

(3) Applicable functional cost centers:

(i) Account 6710--Emergency Services.

(ii) Account 7080--Anesthesiology.

(iii) Account 7210--Laboratory Services--Clinical.

(iv) Account 7230--Laboratory Services--Pathological.

(v) Account 7250--Whole Blood and Packed Red Cells.

(vi) Account 7320--Radiology--Diagnostic.

(vii) Account 7340--C.T. Scanner.

(viii) Account 7360 Radiology Therapeutic.

(ix) Account 7380--Nuclear Medicine.

(x) Account 7420--Respiratory Therapy.

(xi) Account 7610--Physical Therapy.

(g) Medical Staff statistics for the reporting period:

(1) Number of physicians with admitting privileges.

(2) Number of physicians who admitted 20 or more inpatients.

(3) Number of physicians who admitted 100 or more inpatients.

(h) Emergency Room physician contract service (account 6710):

(1) Does the hospital contract for private physician coverage?

(2) If so, is there a guaranteed minimum payment?

(3) If so, what is the amount of this payment for this reporting period?

(4) If so, what is the amount of billed charges for this reporting period?

(5) Do the contract physicians cover on a 24-hour, 7-day-a-week basis?

(6) If not, to what extent is coverage contracted for?

(7) If contract exists, a copy must be submitted.

(i) Residency training program (accounts 8240 and 8250):

(1) Approvals:

(i) American Medical Association; and/or

(ii) American Dental Association.

(2) Data requirements for each specialty for which training Is provided:

(i) Length of program.

(ii) Number of residencies offered (excluding first-year trainees) .

(iii) Number completing program last year.

(iv) Number of American and/or Canadian graduates receiving training this year.

(v) Number of foreign graduates receiving training this year.

(vi) Number receiving training through an affiliated program.

(j) Student RN training program (account 8220):

(1) Length of course.

(2) Number of students.

(3) Tuition charges:

(i) First year $_______.

(ii) Second year $______.

(iii) Third year $______.
 

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PATIENT CLASSIFICATION

Section 446.16 - Source of payment defined

PATIENT CLASSIFICATION

446.16 Source of payment defined.

(a) Medicare.

(b) Blue Cross.

(c) Medicaid.

(d) Workers' Compensation.

(e) Commercial insurance.

(f) Free.

(g) Self-pay in full.

(h) Other.
 

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Section 446.17 - Gross charges by source of payment

446.17 Gross charges by source of payment.

(a) Report gross charges at the hospital's full published rates.

(b) Include Daily Hospital Services (accounts 6010 through 6690).

(c) Include Ambulatory Services (accounts 6710 through 6990).

(d) Include Ancillary Services (accounts 7010 through 7910).
 

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Section 446.18 - Patient days by source of payment

446.18 Patient days by source of payment.

(a) Adults and Pediatrics.

(1) Exclude Routine Newborn.

(2) Exclude Sub-Acute Care Services (account numbers 6610-6690).

(b) Routine Newborn.

(1) Born in hospital.

(2) Discharged with the mother.
 

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Section 446.19 - Discharges by source of payment

446.19 Discharges by source of payment.

(a) Adults and Pediatrics.

(1) Exclude Routine Newborn.

(2) Exclude Sub-Acute Care Services (account numbers 6610-6690).

(b) Routine Newborn.

(1) Born in hospital.

(2) Discharged with the mother.
 

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Section 446.20 - Ambulatory visits by source of payment

446.20 Ambulatory visits by source of payment.

(a) Emergency Services (account 6710).

(1) Number of visits.

(i) Outpatient visits, plus

(ii) Visits resulting in inpatient admissions.

(iii) Total must equal Standard Unit of Measure.

(2) Number of visits, excluding visits resulting in inpatient admissions.

(i) Total visits, less

(ii) Visits resulting in inpatient admissions.

(b) Clinic Services (account 6720).

(1) Number of visits.

(i) Outpatient visits, plus

(ii) Visits resulting in inpatient admissions.

(iii) Total must equal Standard Unit of Measure.

(2) Number of visits, excluding visits resulting in inpatient admissions.

(i) Total visits, less

(ii) Visits resulting in inpatient admissions.

(c) Community Mental Health Center.

(1) Number of visits.

(i) Outpatient visits, plus

(ii) Visits resulting in inpatient admissions.

(2) Number of visits, excluding visits resulting in inpatient admissions.

(i) Total visits, less

(ii) Visits resulting in inpatient admissions.
 

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Section 446.21 - Direct admissions from emergency room

446.21 Direct admissions from emergency room.

(a) To the specific discrete unit under each Daily Hospital Service Area.

(1) Acute Care Services (accounts 6010-6290).

(2) Intensive Care Services (accounts 6310-6410).

(3) Nursery Services (account 6510 or 6520).

(4) Sub-Acute Care Services (accounts 6610-6690).

(b) Total must agree with the difference between Emergency Services visits reported per section 446.20(a)(1)(iii) and section 446.20(a)(2) of this Part.
 

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Section 446.22 - Inpatient care statistics by unit

446.22 Inpatient care statistics by unit.

(a) Basic data requirements.

(1) Number of inpatients treated:

(i) In hospital on first day of reporting period.

(ii) Admissions during current reporting year.

(iii) Total patients treated.

(2) Transfers:

(i) In.

(ii) Out.

(3) Number of discharges:

(i) Deaths.

(ii) Other.

(iii) Total.

(4) Number of patients in hospital on the last day of the reporting period.

(5) Census patient days of care rendered.

(6) Certified bed capacity end of period.

(b) Types of units. Please refer to section 446.44(b) of this Part for all program services for which these statistics are to be reported.
 

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Section 446.23 - Ambulatory care statistics

446.23 Ambulatory care statistics.

(a) Ambulance Service (account 6850).

(1) How many ambulance vehicles do you operate?

(2) Report the total trips made.

(3) Report the number of unnecessary trips.

(4) Report the disposition of patients.

(i) Transfers.

(ii) Admissions.

(iii) Emergency room only.

(iv) Other hospital.

(v) Not removed.

(vi) D.O.A.

(vii) All other dispositions.

(b) Outpatient Department Visits by Clinic (account 6720)

(1) Report each clinic operated by the facility separately.

(2) Refer to section 443.5(b) of this Article for a partial listing.

(3) Report total clinic visits:

(i) Exclude Community Mental Health Center.

(ii) Exclude Free Standing Clinic.

(4) Clinic visits with physician contact.

(5) Clinic visits with non-physician contact.

(6) Number of patients treated--unduplicated count.

(c) Free standing Clinics (accounts 6870, 6880 and 6890).

(1) Name and address.

(2) Funding source (OEO, Title II, etc.).

(3) Type (family, pediatric, etc.).

(4) When is clinic open?

(i) Evenings.

(ii) Weekends.

(5) Walk-in patients:

(i) Do you maintain a screening clinic?

(ii) If so, is it part of a general clinic?

(iii) If not, how are patients assigned?

(6) Number of patients on annual clinic register.

(7) Number of visits during the year by pay classification:

(i) Medicaid.

(ii) Medicare.

(iii) Compensation.

(iv) Blue Cross.

(v) Commercial insurance.

(vi) Free.

(vii) Self-pay in full.

(viii) All other.

(8) Emergency room:

(i) Do you operate one at this Free Standing Clinic?

(ii) If so, report number of visits during reporting period.

(9) Each separate Free Standing Clinic must be reported separately.

(d) Ambulatory Service (account 6720)

(1) Do you have organized clinics at your main hospital facility?

(2) Do you have a Ghetto Medicine Contract?

(3) Do you have a pre-admission testing program?

(i) Report number of patients treated in prior reporting period.

(ii) Report number of patients treated in current reporting period.

(4) Do you have an ambulatory surgical program?

(i) Report number of procedures in prior reporting period.

(ii) Report number of procedures in current reporting period.

(5) Do you operate evening clinic sessions?

(6) Do you operate weekend clinic sessions?

(7) Do you maintain a screening clinic for:

(i) New patients to be seen by a physician?

(ii) If so, is the screening clinic part of a general clinic?

(e) Private (Referred) Ambulatory Patients.

(1) Do you provide for the care of private (referred) ambulatory patients (patients referred by their physician, for specific ancillary services(s), from his private office)?

(2) Report the number of visits for the current reporting period.

(f) Mental Health Services.

(1) Do you provide this service on an ambulatory basis?

(2) If so, are these services provided under contract, in whole or in part, with the Community Mental Health Board?

(3) If so, are these part of an organized Community Mental Health Center?
 

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CAPITAL PLANT

Section 446.24 - Patient accommodations

CAPITAL PLANT

446.24 Patient accommodations.

(a) Patient accommodations certified beds (excluding newborn).

(1) In accordance with Department of Health Operating Certificate.

(i) Number of certified beds at the beginning of the reporting period.

(ii) Number of certified beds at the end of the reporting period.

(2) Please refer to section 446.44(b) of this Part for all program services for which these statistics are to be reported.

(b) Patient accommodations--bed complement (excluding newborn).

(1) Number of beds at the beginning of the reporting period.

(2) Number of beds at the end of the reporting period.

(3) Please refer to section 446.44(b) of this Part for all program services for which these statistics are to be reported.

(c) Patient accommodations--changes in certified beds or bed complement (excluding newborn).

(1) Indicate type of change:

(i) Complement.

(ii) Certified beds.

(2) Indicate clinical service affected.

(3) Indicate date of change.

(4) Indicate number of beds gained.

(5) Indicate number of beds lost.

(6) Indicate pavilion/building and rooms affected.

(7) Indicate, for each change, the final number of beds at the end of the reporting period.

(8) Indicate an explanation of the change.

(d) Patient accommodations--regular newborn bassinets.

(1) Number of bassinets at the beginning of the reporting period.

(2) Number of bassinets at the end of the reporting period.

(3) Specific data required:

(i) Total bassinets.

(ii) Normal bassinets.

(iii) Observation bassinets.

(iv) Isolation bassinets.

(v) Premature bassinets.

(vi) Other bassinets.

(e) Patient accommodations--changes in regular newborn bassinets.

(1) Type of bassinet changed:

(i) Normal.

(ii) Observation.

(iii) Isolation.

(iv) Premature.

(v) Other.

(2) Date of change.

(3) Number of bassinets gained.

(4) Number of bassinets lost.

(5) The number of bassinets at the end of the reporting period.

(6) An explanation of the change.

(f) Patient accommodations- specialized beds.

(1) Number of specialized beds at the beginning of the reporting period.

(2) Number of specialized beds at the end of the reporting period.

(3) Types of specialized beds:

(i) Kidney Dialysis Unit (not in a discrete unit).

(ii) Recovery room.

(iii) Other (specify).

(g) Capital plant--real property owned.

(1) Data required:

(i) Location of real property.

(ii) Description of real property.

(iii) Use of real property.

(2) Categories of real property:

(i) Land and buildings (hospital owns both).

(ii) Land only (hospital owns; is it vacant, are you renting/leasing any structures on this land).

(iii) Building only (hospital owns building and does not own land).

(h) Capital plant real property leased by provider.

(1) Data required:

(i) Location of real property.

(ii) Description of real property.

(iii) Use of real property.

(2) Categories of real property:

(i) Land and buildings (hospital leases both).

(ii) Land only (hospital leases and keeps it vacant).

(iii) Building only (leases building and does not own the land).
 

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SERVICES PROVIDED AND GOODS USED

Section 446.25 - Home medical care program

SERVICES PROVIDED AND GOODS USED

446.25 Home Medical Care Program. (a) Each functional cost center (6910-6990) must be reported separately.

(b) Report data regardless of participation in AHS program.

(c) Service data to be provided:

(1) Patients on Home Care first day of reporting period.

(2) Admissions to Home Care during the reporting period.

(3) Total patients under care.

(4) Deaths on Home Care.

(5) All other discharges from Home Care.

(6) Total discharges from Home Care.

(7) Patients remaining on Home Care on last day of reporting period.

(8) Total days of care provided during the reporting period.

(d) Do not report this data, under either inpatient or outpatient services, in any other area.

(e) Exclude Home Program dialysis.
 

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Section 446.26 - Organized Drug Addiction Program

446.26 Organized Drug Addiction Program. (a) Please indicate the types of patients treated:

(1) Inpatient:

(i) Adult.

(ii) Adolescent.

(2) Ambulatory:

(i) Adult.

(ii) Adolescent.

(b) Please indicate the type of unit you have:

(1) Inpatient:

(i) Detoxification.

(ii) Maintenance.

(2) Ambulatory:

(i) Detoxification.

(ii) Maintenance.

(c) Please provide the following statistics:

(1) Inpatient:

(i) Number of beds.

(ii) Number of admissions during the reporting period.

(iii) Number of patient days during the reporting period.

(2) Ambulatory:

(i) Register of patients on last day of reporting period.

(ii) Total number of different patients treated during the reporting period.

(iii) Total number of visits during the reporting period.
 

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Section 446.27 - Organized alcoholic treatment program

446.27 Organized Alcoholic Treatment Programs.

(a) Types of patients served:

(1) Outpatients.

(2) Inpatients.

(3) Both.

(b) Please indicate the following data for inpatient programs:

(1) Number of certified beds at the end of the reporting period.

(2) Number of admissions during the reporting period.

(3) Number of patient days rendered during the reporting period.

(c) Please indicate the following data for outpatient programs:

(1) Register of patients on last day of reporting period:

(2) Total number of different patients treated during the reporting period.

(3) Total number of visits during the reporting period.
 

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Section 446.28 - Selected special service statistics

446.28 Selected special service statistics. (a) Statistical requirements.

(1) Laboratory Services--Clinical (account 7210)--number of procedures.

(2) Laboratory Services--Pathological (account 7230)--number of procedures.

(3) Electrocardiology (account 7290)--number of examinations.

(4) Neurology Diagnostic (account 7486)--number of electroencephalography examinations.

(5) Radiology--Diagnostic (account 7320):

(i) Number of films.

(ii) Number of procedures.

(iii) Diagnostic isotope procedures.

(6) Radiology Therapeutic (account 7360)--number of treatments:

(i) Superficial treatments.

(ii) Orthovoltage treatments.

(iii) Megavoltage (including Gamma) treatments.

(7) Physical Therapy (account 7510)--number of treatments.

(8) Surgery Services (account 7040):

(i) Total number of persons undergoing surgery.

(ii) Number undergoing surgery in the operating room (exclude open heart).

(iii) Number undergoing surgery elsewhere (exclude open heart).

(iv) Number receiving open heart surgery (with pump-without pump).

(v) Number of cystoscopy room procedures.

(9) Whole Blood and Packed Red Cells (account 7250)--number of transfusions.

(10) Labor and Delivery Services (account 7010) :

(i) Number of deliveries.

(ii) Number of live births.

(11) Cardiac Catheterization Laboratory (account 7310)--number of procedures.

(12) Respiratory Therapy (account 7420)--number of oxygen minutes.

(13) Radiology--Diagnostic (account 7320):

(i) Number of angiocardiography procedures.

(ii) Number of Arteriography procedures.

(iii) Number of Cinefluorography procedures.

(14) Laboratory Services--Pathological (account 7230)--Tissue typing--number of tissues typed.

(15) Organs harvested (various accounts):

(i) Number of eyes harvested.

(ii) Number of kidneys harvested.

(iii) Number of other organs harvested.

(b) Distribution of statistical requirements.

(1) Please refer to section 446.44(b) of this Part for all inpatient program services for which these statistics are to be reported.

(2) Please refer to section 446.44(c) of this Part for all outpatient program services for which these statistics are to be reported.
 

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ADDITIONAL INFORMATION

Section 446.29 - Additional information

ADDITIONAL INFORMATION

446.29 Additional information. (a) Are any hospital employees represented by a labor organization?

(b) If so, please provide the following data for each representation unit:

(1) Complete name of representation unit (including local designation).

(2) Number of employees in unit.

(3) Expiration date of current contract(s).
 

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UPSTATE BLUE CROSS SUPPLEMENTAL DATA

Section 446.30 - Cost allocation adjustments

UPSTATE BLUE CROSS SUPPLEMENTAL DATA
446.30 Cost allocation adjustments.
Account
Description of adjustment Cost center affected number
(a) Interest on inter-fund borrowing
(1) Funded depreciation (i) Interest--Short-Term, or 8870
(ii) Interest--Long-Term 8880
(2) Donor-restricted funds (i) Interest--Short-Term, or 8870
(ii) Interest--Long-Term 8880
(3) Other (specify) (i) Interest--Short-Term, or 8870
(ii) Interest--Long-Term 8880
(b) Unincorporated business tax Provision for Income Taxes 9410
(c) Corporate income taxes Provision for Income Taxes 9410
(d) Unrecovered cost of courtesy Employee Benefits-- allowances to employees and Non-Payroll-Related 8830 dependents
(e) Voluntary Agency Proficiency Testing Program
(1) Clinical laboratory Laboratory Services--Clinical 7210
(2) Other (specify) Specify Specify
(f) Grants, gifts and income for specific purposes Specify Specify
(g) Depreciation--straight Depreciation and Amortization-- line to accelerated Movable Equipment 8820
(h) 28B funding requirements
(1) Building and fixtures Depreciation/Amortization-- Fixed Assets 8810
(2) Movable equipment Depreciation/Amortization-- Movable Equipment 8820
(i) Hospital-based physicians on direct physician billing
(1) Diagnostic X-ray (i) Radiology--Diagnostic, and/or 7320
(ii) CT Scanner, and/or 7340
(iii) Radiology--Therapeutic, and/or 7360
(iv) Nuclear Medicine 7380
(2) Laboratory (i) Laboratory Services-- Clinical, and/or 7210
(ii) Laboratory Services-- Pathological, and/or 7230
(iii) Blood Storing and 7260 processing
(3) Electrocardiology Electrocardiology 7290
(4) Emergency room physicians Emergency Services 6710
(j) Other (specify) Specify Specify
(k) Amounts may be expressed as:
(1) increases; or
(2) decreases

 

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Section 446.31 - Lease schedule

446.31 Lease schedule. (a) For each individual lease arrangement, please provide:

(1) Name of the leasing company.

(2) Description of equipment leased.

(3) Term (from-to) of lease agreement.

(4) Amount of the monthly lease payment.

(5) Total cost recorded on the cost report.

The grand total of cost reported on the cost report should equal the amount reported for account 8825, Leases and Rentals--Movable Equipment.
 

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Section 446.32 - Statistical data

446.32 Statistical data. (a) Sick baby statistics.

(1) Specific statistics required:

(i) Sick baby patient days.

(ii) Sick baby discharges (excluding transfers).

(2) Program services for which statistics are to be reported:

(i) Newborn Nursery (account 6510).

(ii) Premature Nursery (account 6520).

(iii) Pediatric Acute Care (account 6170).

(iv) Pediatric intensive Care (account 6350).

(v) Neo-Natal Intensive Care (account 6370).

(3) A sick baby is defined as a baby diagnosed sick or premature.

(b) Leave day statistics. (1) Leave days are defined as days occurring after the admission and prior to the discharge of a hospital inpatient when the patient is not present at the census-taking hour.

(i) Patient is charged for the days he is on leave.

(ii) Bed is reserved for that patient.

(2) If the hospital has leave days, the following information is required: (i) Were leave days included in the Standard Unit of Measure Statistics for Daily Hospital Services (accounts 6010-6690)?

(ii) If so, please detain where they were reported (refer to section 446.44 (b) of this Part for all program services for which this statistic must be reported).

(iii) If not, please detail how they should be reported (refer to section 446.44 (b) of this Part for all program services for which this statistic must be reported).
 

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DOWNSTATE BLUE CROSS SUPPLEMENTAL DATA

Section 446.33 - Adjustments to expense

DOWNSTATE BLUE CROSS SUPPLEMENTAL DATA

446.33 Adjustments to expense.

Account Description of adjustment Cost center affected number

(a) Unrecovered cost of courtesy Employee Benefits--Non Payroll-Related 8830

(b) Allowances to employees and

dependents

(c) Collection fees Patient Accounts, Admitting and Registration 8520

(d) Interest on inter-fund (1) interest--Short-Term, or 8870 borrowing (2) interest--Long-Term 8880

(e) Grants from governmental or public philanthropic agencies (lower of expense or grant) Specify Specify

(f) Depreciation accelerated Depreciation and Amortization-- to straight line Fixed Assets 8810

(g) Other (specify) Specify Specify

(h) The amounts of these adjustments may be expressed as:

(1) increases; or

(2) decreases.
 

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Section 446.34 - Services not covered

446.34 Services not covered. (a) Specific services not covered.

(1) Blood (account 7250--Whole Blood and Packed Red Cells).

(2) Blood Plasma (account 7150--Drugs Sold).

(3) Special Appliances for patients:

(i) Chargeable (account 7110--Medical Supplies Sold).

(ii) Nonchargeable (cost center utilizing the appliance).

(4) Other (specify):

(b) Program services for which data is to be reported.

(1) Inpatients:

(i) Acute Care (accounts 6010 through 6290), plus

(ii) Intensive Care (accounts 6310 through 6410).

(2) Newborn Nursery (account 6510).

(3) Premature Nursery (account 6520).

(4) Other (specify).

(5) Emergency Services (account 8710).
 

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Section 446.35 - Other data required

446.35 Other data required. (a) Blue Cross patient days by program service in section 446.44(b) of this Part.

(b) Collection fees applicable to Blue Cross patients by program service in section 446.44(b) of this Part.

(c) Per diem collection expense applicable to Blue Cross patients (collection fees divided by patient days) by program service in section 446.44(b) of this Part.
 

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BOTH BLUE CROSS PLANS--SUPPLEMENTAL DATA

Section 446.36 - Supplemental data for both upstate and downstate Blue Cross plans

BOTH BLUE CROSS PLANS -- SUPPLEMENTAL DATA

446.36 Supplemental data for both upstate and downstate Blue Cross plans.

(a) Computation of capital invested in tangible assets at the beginning of the period.

(1) Applies to proprietary facilities only.

(2) Calculation of balance as of the beginning of the period:

(i) Total assets at the beginning of the period.

(ii) Subtract total liabilities at the beginning of the period.

(iii) Net capital of the facility at the beginning of the period.

(iv) Subtract intangible assets at the beginning of the period.

(v) Capital in tangible assets as at the beginning of the period.

(vi) Add accumulated depreciation on buildings and fixed equipment as at the beginning of the period.

(vii) Balance carried forward to next section.

(b) Return on capital invested in tangible assets. (1) Applies to proprietary facilities only.

(2) Calculations by month:

(i) Take capital invested in tangible assets at beginning of the month.

(ii) Add capital investments during the month.

(iii) Subtract withdrawals or dividend distributions during the month.

(iv) Add or subtract one twelfth of the increase or decrease due to operations for the year.

(v) Add or subtract other (specify) items.

(vi) The result of the above is capital invested in tangible assets at the end of the month.

(3) Beginning balance for first month of the reporting period equals the results of the calculation in subdivision (a) of this section.

(4) Repeat above for each month of the reporting period.

(5) Average the capital invested in tangible assets at the end of each month.

(6) Increase or decrease due to operations must be reflected net of depreciation on buildings and fixed equipment.

(c) Physician costs. (1) Amounts paid to physicians must be reported by cost center to which they are assigned.

(2) Applicable physician categories:

(i) Interns and residents;

(ii) Supervising physicians;

(iii) Hospital-based physicians.

(3) Costs to be reported for:

(i) Ancillary Services (accounts 7010-7910).

(ii) Daily Hospital Services (accounts 6010-6690).

(iii) Ambulatory Services (accounts 6710-6990).

(iv) Referred Ambulatory Services.

(v) Sold Services.

(vi) Nonreimbursable areas.
 

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MEDICAID SUPPLEMENTAL DATA

Section 446.37 - Cost allocation adjustments

MEDICAID SUPPLEMENTAL DATA

446.37 Cost allocation adjustments.

Account Adjustment Cost center affected number

(a) Depreciation--replacement cost to historical cost

(1) Buildings and fixtures Depreciation and Amortization-- Fixed Assets 8810

(2) Equipment Depreciation and Amortization-- Movable Equipment 8820

(b) Depreciation--accelerated Depreciation and Amortization-- to straight line-- Fixed Assets 8810 buildings and fixtures

(c) Interest on inter-fund borrowing

(1) Funded depreciation (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(2) Donor-restricted funds (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(3) Other (specify) (i) Interest--Short-Term, or 8870

(ii) Interest--Long-Term 8880

(d) Unincorporated business Provision for Income Taxes 9410 tax

(e) Corporate income tax Provision for Income Taxes 9410

(f) Unrecovered cost of Employee Benefits--Non courtesy allowances to Payroll-Related employees and dependents 8830

(g) Voluntary Agency Proficiency Testing Program

(1) Clinical laboratory Laboratory Services--Clinical 7210

(2) Other (specify) Specify Specify

(h) Grants, gifts and income for specific purpose Specify Specify

(i) Professional standards Medical Care Review 8740 review organization

Other (specify) Specify Specify

(j) Amounts may be expressed as:

(1) increases; or

(2) decreases.
 

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Section 446.38 - Funded depreciation calculation

446.38 Funded depreciation calculation. (a) Calculation to determine extent of depreciation funding.

(1) Total depreciation expense for reporting period:

(i) Depreciation and Amortization--Fixed Assets (account 8810), plus

(ii) Depreciation and Amortization--Movable Equipment (account 8820).

(2) Source and amount of cash disbursed for capital assets:

(i) Unrestricted Fund (exclude borrowed from outside sources).

(ii) Specific purpose funds.

(iii) Plant replacement and expansion funds.

(iv) Endowment funds.

(3) Payments made during year to reduce capital debt (principal only).

(4) Change in composition of depreciation fund balance.

Subtract balance at the end of the prior reporting period from balance at the end of the current reporting period for total assets, total liabilities and fund balances.

(5) Maximum allowable depreciation expense:

(i) Take the total amount of cash disbursed for capital assets.

(ii) Add payments made to reduce capital debt.

(iii) Add or subtract increase or decrease in depreciation fund balance.

(6) Depreciation not funded:

(i) If maximum allowable depreciation expense exceeds or is equal to total depreciation expense reported, depreciation has been fully funded.

(ii) If maximum allowable depreciation expense is less than total depreciation expense reported, the depreciation funding requirement has not been met.

(b) Total depreciation expense for the reporting period (paragraph (a)(1) of this section) should reflect Medicaid adjustments (section 446.37 of this Part).
 

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Section 446.39 - Funded depreciation waiver

446.39 Funded depreciation waiver.

(a) If funding requirement is not met, do you wish to apply for a waiver?

(b) If so, the following information must be provided:

(1) A narrative of the reasons for your request.

(2) Provide the status of your unrestricted resources:

(i) Does the hospital have unrestricted funds temporarily serving as specific purpose funds, plant replacement and expansion funds, or endowment funds?

(ii) Does the hospital have restricted funds temporarily serving as specific purpose funds, plant replacement and expansion funds, or endowment funds?

(iii) If any question is answered yes, the amounts must be reported.
 

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Section 446.40 - Rent and equity

446.40 Rent and equity.

(a) Does any rent expense you reported remain in the New York State Cost Allocation process?

(1) Leases and Rentals--Fixed Assets (account 8815); or

(2) Leases and Rentals--Movable Equipment (account 8825) .

(b) If yes, report the following:

(1) For each lessor organization, report the amount of rent expense:

(i) fixed assets, separately from

(ii) movable equipment.

(2) Provide the name of the lessor organization and indicate if:

(i) you have an arm's length arrangement, or

(ii) a non-arm's length arrangement.

(c) If a non-arm's length arrangement exists, the owner/lessor must provide:

(1) Actual expense relative to the asset leased/rented:

(i) Depreciation.

(ii) Mortgage interest.

(iii) Insurance.

(iv) Property taxes.

(v) Other (specify).

(2) Condensed balance sheet relative to the asset leased/rented:

(i) Total assets.

(ii) Total liabilities.

(iii) Total capital (equity).

(d) Definition of non-arm's length arrangement.

(1) Operator of proprietary facility has more than a 10 percent interest in the equity of a company providing real property, goods or services to the facility.

(2) An interest in the equity means an operator has ownership or control, direct or indirect, in such a company.
 

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Section 446.41 - Hospital-based home health agencies

446.41 Hospital-based home health agencies.

(a) Hospitals desiring rates for HHS services must:

(1) Provide the Home Health Agency NYS Operating Certificate Number; and

(2) Ratio of Charges to Charges Applied to Costs (RCCAC) information.

(b) RCCAC information.

(1) Statistics required:

(i) Number of hours of service.

(ii) Number of home health visits.

(iii) Charge per visit at the hospital's established rates.

(iv) Multiply number of home visits by the charge per visit.

(2) Specific home health services for which statistics above are required:

(i) Skilled Nursing Care (account 6910).

(ii) Medical Social Services (account 6920).

(iii) Home Health Aides (account 6930).

(iv) Physical Therapy (account 7510).

(v) Occupational Therapy (account 7530).

(vi) Speech/Language Pathology (account 7550).

(vii) Other Home Health Services (account 6990).

(3) The total charges calculated in paragraph (b) (1) of this section must be summed for all services in paragraph (b) (2) of this section.

(4) A percentage of each service in paragraph (b) (2) of this section to the total charges in paragraph (b) (3) of this section must be calculated (to the nearest tenth of a percent).

(c) Show visits and charges only for approved HHA services.

(d) Does your hospital contract for any HHA services?

(1) If so, is charge dependent on the amount charged by the contracting agency?

(2) If so, detail the visits and charges according to each contract under paragraph (b)(2) of this section.
 

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Section 446.42 - Ambulance service

446.42 Ambulance service.

(a) The costs of this service, regardless of how it is provided, must be reported as follows:

(1) As an ambulatory program service.

(2) Under account 6850--Ambulance Services.

(b) Data to be reported if the service exists.

(1) Does this service apply to Medicaid recipients in the same manner as all other recipients of this service?

(2) If not, explain:

(i) Reason for this policy.

(ii) Extent that Medicaid Service has been excluded from the amount reported.
 

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Section 446.43 - Physician cost

446.43 Physician cost.

(a) Please refer back to section 440.6(e)(4)(vii)(c)(3) of this Article.

(b) The requirements indicated there for Blue Cross apply equally to Medicaid.
 

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PROGRAM SERVICES FOR SUPPLEMENTAL DATA

Section 446.44 - Program services for supplemental data

PROGRAM SERVICES FOR SUPPLEMENTAL DATA

446.44 Program services for supplemental data.

(a) In an effort to standardize the reporting categories for the supplemental data required in this Part and to be consistent with the other sections of this Article, the Program Service Areas for which the supplemental data must be reported are being specified in this section. Subdivision (b) of this section specifies these Program Service Areas for the Daily Hospital Services accounts. Subdivision (c) of this section specifies these Program Service Areas for the Ambulatory Services accounts.

(b) Program Service Areas for Daily Hospital Services.

Account number Account name

(1) ACUTE CARE

6010 Medical/Surgical

6170 Pediatric

6210 Psychiatric

6250 Obstetrics

6280 Definitive Observation

6290 Other Acute Care

(2) INTENSIVE CARE SERVICES

6310 Medical/Surgical

6330 Coronary

6350 Pediatric

6370 Neo-Natal

6380 Burn

6390 Psychiatric

6410 Other Intensive Care I

6420 Other Intensive Care II

6430 Other Intensive Care III

(3) NURSERY SERVICES

6510 Newborn Nursery

6520 Premature Nursery

(4) SUB-ACUTE CARE SERVICES

6610 Skilled Nursing Care--Medicare/Medicaid Certified

6620 Skilled Nursing Care--Medicaid Certified

6630 Psychiatric Long-Term

6640 Tuberculosis Long-Term Care

6660 Intermediate Care--Other

6670 Residential Care

6680 Other Sub-Acute Care Services

(c) PROGRAM SERVICE AREAS FOR AMBULATORY SERVICES

6710 Emergency Services

6720 Clinic Services

6810 Home Program Dialysis Equipment-- 100%

6820 Home Program Dialysis Equipment--Other

6830 Ambulatory Surgery

6840 Psychiatric Day/Night

6850 Ambulance Services

6860 Other Ambulatory Services

6870 Free Standing Clinic I

6880 Free Standing Clinic II

6890 Free Standing Clinic III

6910 Home Health Services--Skilled Nursing Care

6920 Home Health Services--Medical Social Services

6930 Home Health Services--Home Health Aides

6990 Home Health Services--Other Home Health

None Referred Ambulatory Services

None Sold Services

None Outpatient Renal Dialysis
 

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Part 447 - Standard Unit Of Measure References

Effective Date: 
Tuesday, December 23, 1980
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Statutory Authority: 
Public Health Law, Section 2803-b

Section 447.1 - Laboratory Services

447.1 Laboratory Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7210 Laboratory Services--Clinical

7230 Laboratory Services--Pathological

7250 Whole Blood and Packed Red Cells

7260 Blood Processing and Storing

7290 Electrocardiology

7440 Pulmonary Function Testing

(b) The above cost centers use as the basis for the Standard Unit of Measure the Laboratory Workload Recording Method published by the College of American Pathologists (CAP). The college has a policy of revising their publication annually and it is available in January of each year. The latest edition is to be used for determining the standard units of measure for tests and procedures performed. In recording Workload Measurement Units for reporting to the Health Care Financing Administration (HCFA), workload units related to quality control studies, calibration standards, and specimen collection, and repeats and duplicates for which a patient is not charged are not to be counted. Workload units for unlisted tests and 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.

(c) Copies of the Laboratory Workload Recording Method can be obtained by writing to:

College of American Pathologists

7400 North Skokie Boulevard

Skokie, Ill. 60076
 

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Section 447.2 - Radiology Services

447.2 Radiology Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7320 Radiology--Diagnostic

7360 Radiology--Therapeutic

7380 Nuclear Medicine

(b) The above cost centers use as the basis for the Standard Unit of Measure the Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies (RVS). Relative Value Units for unlisted BR (By Report), and RNE (Relativity Not Established) procedures are to be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. Use the "Total Unit Value", not the "PC Unit Value", in recording the relative value unit counts. Because the California Medical Association is no longer publishing their Relative Value Studies booklet, the Radiology/Nuclear Medicine chapter is set forth as subdivisions (c)-(g) of this section with the approval of CMA.

(c) RADIOLOGY AND NUCLEAR MEDlClNE GROUND RULES

(1) GENERAL: Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician.

(i) The total unit value includes the professional component (see PC unit value below) plus the technical component. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). This value is applicable in any situation in which a single charge is made to include both professional services and the technical cost of providing that service.Identification of a procedure by its 5-digit code without modifier -26 or -27 indicates that the charge includes both the "professional" and "technical" components.

(ii) The PC unit value (professional component unit value) represents the value of the professional radiological services of the physician. This includes examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and written report of the examination and consultation with the referring physician. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). This component is applicable in any situation in which the physician submits a charge for these professional services only. It does not include the cost of personnel, materials, space, equipment or other facilities. To identify a charge for professional component, use the 6-digit procedure code followed by modifier -26. (See modifier -26 and Appendix 1 for use of modifiers.)

(iii) When this section of the RVS is used in connection with a "conversion factor" to establish fees, it must be emphasized that the SAME conversion factor cannot be applied to both the TOTAL UNIT VALUE and the PROFESSIONAL COMPONENT UNIT VALUE. Physicians who determine their fees by application of conversion factors to the unit values in this section must determine a separate factor for TOTAL UNIT VALUE and for PC UNIT VALUE.

(iv) The technical component includes the charges for personnel, materials, including usual contrast media and drugs, film or xerograph, space, equipment and other facility but excludes the cost of radioisotopes. No unit values are listed for the technical component of radiology procedures, since these are institutional charges not billed separately by physicians. To identify a charge for the technical component, use thc 5-digit procedure code followed by modifier -27. (See modifier -27 and Appendix 1 for use of modifiers.)

(2) UNUSUAL SERVICE OR PROCEDURE: A service may necessitate skills and time of the physician over and above listed services and values. If substantiated "by report," additional values may be warranted. (See unit value modifier -22 and rule 4, below.)

(3) UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is provided, the values used should be substantiated "by report." (See rule 4 below.) Identify by unlisted procedure number in appropriate section. For a comprehensive listing, see pages 15-16.

(4) PROCEDURES LISTED WITHOUT SPECIFIC UNIT VALUES:

(i) BY REPORT "BR" ITEMS: BR in the value column indicates that the value of this service is to be determined "by report," because the service is too unusual or variable to be assigned a unit value. Pertinent information concerning the nature, extent and need for the procedure or service, the time, the skill and equipment necessary, etc., is to furnished. A detailed clinical record is not necessary.

(ii) RELATIVITY NOT ESTABLISHED "RNE"ITEMS: RNE in the value column indicates new or infrequently performed services for which sufficient data have not been collected to allow establishment of a relative value. A report may be necessary. (5) MATERIALS SUPPLIED BY PHYSICIAN: Identify as 99070. (Radionuclides are identified as 99069.) Supplies and materials provided by the physician (e.g., sterile trays, drugs, etc.) over and above those usually included with the office visit or other services rendered may be charged for separately. (List drugs, trays, materials or supplies provided.)

(6) INJECTION PROCEDURES: Values for Injection procedures include all usual pre- and post-injection care specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter, and injection of contrast media. Vascular injection procedures are listed in the cardiovascular section, under procedure codes 36000-36299. Other injection procedures are listed in appropriate sections. The injection procedure is included in the unit value for radiographic procedures marked with a small star (*).

(7) MISCELLANEOUS:

(i) A physician may elect to reduce the listed value of a service for a variety of reasons. To identify such charges, see modifier -52.

(ii) Examination outside of regular hours, at bedside or in operating room, may warrant an additional charge for technologist's time (see 99065, 99066).

(iii) Values for office, home and hospital visits, consultation and other medical services, anesthesia, surgical and laboratory procedures are listed in the sections entitled "Medicine," "Anesthesia," "Surgery" and "Pathology."

(8) SPECIAL SERVICES AND BILLING PROCEDURES:

(i) The following services are generally not part of the basic services as listed in the RVS, but do involve additional expense to the physician for materials, for his time or that of his employees. Those services that are generally provided as an adjunct to common medical services should be charged for only when circumstances clearly warrant an additional charge over and above the usual charges for the basic services.
Unit Value
(ii) 99065 Examination outside of regular hours maywarrant an additional charge for technologist'stime ........................................... 1.3(R)
(iii) 99066 Examination at bedside or in operating room,unless otherwise indicated, may warrant anadditional charge for technologist's time ...... 1.3(R)
(iv) 99069 Radiopharmaceutical or other radionuclidematerial cost. Listed values in this section donot include these costs. List the name ofradiopharmiceutical, dosage and cost ........... BRt
(v) 99070 Supplies and material provided by the physician(e.g., sterile trays, drugs, etc.), over and abovethose usually included with the office visit orother services rendered may be charged forseparately. List drugs, trays, supplies ormaterials provided ............................. BRt
(vi) 99080 Special Reports (e.g., Insurance forms, narrativereports, review of medical records): Wheninformation more than that necessary to establishor to clarify a patient's status is requested(e.g., more than the standard reporting form) or arequest is made for review of medical records andreport, a charge adequate to cover the value ofthe additional service is justifiable .......... BRt
(9) UNIT VALUE MODIFIERS.

(i) Listed values for most procedures may be modified undercertain circumstances as listed below. When applicable, themodifying circumstances should be identified by the addition ofthe appropriate "modifier code number" (including the hyphen)after the usual procedure number. The values should be listed asa single modified total for the procedure. When multiplemodifiers are applicable to a single procedure, see modifier-99.
Unit Value
(ii) -22 Unusual services: When the services provided aregreater than those usually required for the listedprocedure, identify by adding this modifier (-22)to the usual procedure number. List modified value.May require report.
(iii) -28 Professional component: Under certain circumstancesthe physician may wish to submit a charge for theprofessional component of a procedure and not forthe technical component. (See definition ofprofessional component under Ground Rule 1). Underthese circumstances the professional component chargeis identified by adding this modifier (-28) to theusual procedure number and valued according to the"PC unit value" for that procedure.(iv) -27 Technical component: Under certain circumstances, acharge may be made for the technical component alone(see definition of technical component under GroundRule 1). Under those circumstances the technicalcomponent charge is identified by adding thismodifier (-27) to the usual procedure number.
(v) -52 Reduced values: Under certain circumstances, thelisted value is reduced or eliminated because ofground rules, common practice, or at the physician'selection (e.g., a physician may elect to reduce thelisted values in a patient with multiple injuriesrequiring extensive radiographic examination). Underthese or similar circumstances, the services providedcan be identified by their usual procedure numbersand the use of a reduced value indicated by addingthis modifier (-52) to the procedure number. (Useof this modifier provides a means of reportingservices at reduced charge without disturbing usualrelative values.)
(vi) -90 Reference (outside) laboratory: When laboratoryprocedures are performed by other than the billingphysician, the procedure(s) shall be identified byadding this modifier (-90) to the usual single orpanel procedure number and shall be billed as chargedto the physician. (For collection and handlingcharges, see 99007 et seq.)
(vii)-99 Multiple modifiers: Under certain circumstances,multiple modifiers may be applicable (e.g., aphysician may perform services greater than thoseusually required (modifier -22)) and bill theprofessional component (modifier -26)). Underthese circumstances, identify by adding this modifier(-99) to the usual procedure number and brieflyindicate the circumstances. Value in accordance withappropriate modifiers ............................... BRt
(d) DIAGNOSTIC RADIOLOGY. (1) Definitions.
(i) Limited examination: An examination which usually includesAP and lateral views but is less than the "complete examination"defined below. This may be due to limitation of routine viewsby the physician; limitation for a specific purpose (e.g., APand lateral views on post-reduction fracture of ankle); ornecessary limitation due to the condition of the patient (e.g.,single views for fractures in critically injured patient).
(ii) Complete examination: An examination which includes all ofthe necessary views for optimal examination of the part for thesuspected condition. All listed values are for completeexaminations unless otherwise indicated. Necessary additionalmethods cf examination (e.g., fluoroscopy, tomography,cineradiography) may be charged for separately.
(2) Head and Neck.
70002 Pneumoencephalography.............. 25.0(For injection procedure forpneumoencephalography, see61053, 62286)
70010 Cisternography, positivecontrast (posterior, fossamyelography........................ RNE~(For injection procedure, see61052, 61053)
70020 Ventriculography, air or positivecontrast........................... 15.5(For injection procedures forventriculography, see 61025,61030, 61120)
70022 Stereotactic localization.......... BR**
*70024 Computer assisted tomography,cerebral (e.g., EMI scan), withor without intravenous contrast,limited (2 or 3 scans)............. RNE~
*70025 complete (4 scans)................ RNE
*70028 each additional scan above 4....... RNE~
70030 Eye, for detection of foreignbody............................... 5.2
70040 for localization of foreignbody (70030 not included).......... 8.4
70050 combined 70030 and 70040........... 10.5
70100 Mandible, limited orunilateral......................... 3.8
70110 complete........................... 5.9
70120 Mastoid(s), limited orunilateral......................... 3.8
70130 complete and bilateral............. 7.6
70134 Internal auditory measures......... 7.1
*70136 Middle and Inner ear,polytomography..................... RNE
70140 Facial bones, limited.............. 4.4
70150 complete, and/or orbits............ 6.4
70154 with nasal bones................... 7.3
70160 Nasal bones ....................... 3.9
70170 Nasolacrimal duct(dacryocystography)................ 5.9(For injection procedure fordacryocystography, see 68850)70190 Optic foramina .................... 3.8
70210 Paranasal sinuses limited.......... 3.1
70220 complete........................... 6.4
70240 Sella Turcica...................... 3.3
70250 Skull, limited .................... 3.8
70260 complete........................... 7.1
70300 Teeth, single view................. 1.3
70310 partial examination, less thenfull mouth ........................ 2.5
70320 complete examination, fullmouth.............................. 4.7
70330 Temporomandibular joints........... 5.6
70350 Cephalogram (orthodontic).......... RNE
70360 Neck for soft tissues.............. 2.7
*70368 Soft palate, cineradiography orvideotape.......................... RNE
*70373 Laryngography, contrast............ 8.2(For injection procedure forlaryngography, see 31708)
70380 Salivary gland for calculus........ 3.8
70390 Sialography........................ 5.1(For injection procedure forsialography, see 42550)
*70400 Orbitography, air or positivecontrast........................... BR**(For injection procedure fororbitography, see 67510)
*70999 Unlisted procedure, head andneck............................... BR**
(3) Chest.
71000 Chest, "minifilm".................. 1.2
71010 Chest, single view................. 2.5
71020 two views.......................... 3.8
*71021 three views........................ 4.4
71030 complete, minimum of fourviews.............................. 4.9

71034 including fluoroscopy.............. 6.4(For independent chestfluoroscopy, see 76000)
*71036 Fluoroscopic localization forneedle biopsy of intrathoraciclesion, including follow-upfilms.............................. BR**(For biopsy procedure, see 32420)
*71038 Fluoroscopic localization forbronchial brush biopsy or fiberoptic bronchoscopy, includingfilms.............................. BR**(For biopsy procedure, see 31717)
71040 Bronchography, unilateral.......... 9.1
71060 bilateral.......................... 13.0(For injection procedure forbronchography, see 31710, 31715)
*71090 Fluoroscopy and radiographyfor pacemaker insertion............ BR**(For extended room time, see76001)
*71100 Ribs, unilateral................... 4.4
71110 bilateral.......................... 5.4
71120 Sternum............................ 3.8
71130 Sternoclavicular joint(s).......... 3.8
*71199 Unlisted procedure, chest.......... BR**
(4) Spine and Pelvis.
72010 Spine, entire, survey study (APand lateral)....................... 9.3
*72020 Spine, any level, single view...... RNE
72040 cervical, AP and lateral........... 3.8
72050 complete........................... 6.0
72052 including flexion and extensionviews.............................. 7.7
72070 thoracic........................... 4.4
72080 thoraco-lumbar junction ........... 4.4
72090 scoliosis study.................... 3.5
72190 lumbar, limited ................... 4.4
72110 lumbosacral, complete ............. 7.4
72114 including bending views............ 9.3
72120 bending views only................. 4.7
72170 Pelvis, limited.................... 3.1
72180 stereo............................. 3.8
72190 complete........................... 4.9(For pelvimetry, see 74710)
72202 Sacro-iliac joints ................ 5.1
72220 Sacrum and coccyx ................. 4.1
72250 Myelography, lumbar or anyother single levels ............... 11.5
72270 all levels......................... 18.0
*72275 gas................................ BR**(For injection procedures formyelography, see 62284)
72290 Discography, lumbar or cervical.... 12.2(For injection procedures fordiscography, see 62290, 62291)
*72299 Unlisted procedures, spine orpelvis............................. BR**
(5) Upper Extremities.
73000 Clavicle........................... 3.1
73010 Scapula............................ 3.8
73020 Shoulder, limited.................. 2.7
73030 complete........................... 3.8
73040 arthrography....................... 6.4(For injection procedure forarthrography, see 23350)73050 Acromio-clavicular joints, bilateral, with or without weighteddistraction........................ 4.4
73060 Humerus, including one joint....... 3.1
73070 Elbow limited...................... 2.8
73080 complete........................... 3.8
*73085 arthrography....................... BR**(For injection procedure, see24220)
73090 Forearm, including one joint....... 3.0
73100 Wrist, limited..................... 2.5
73110 complete........................... 3.8
*73115 arthrography....................... BR**(For injection procedure, see25246)
73120 Hand, limited...................... 2.5
73130 complete .......................... 3.5
73140 Finger(s).......................... 2.3
*73499 Unlisted procedure, upperextremities........................ BR**
(6) Lower Extremities.
73500 Hip, unilateral limited ........... 3.1
73510 complete (including AP pelvis)............................... 4.4
*73515 bilateral, limited (e.g., infantAP and frog lateral................ 3.9
73520 bilateral, complete (includingAP of pelvis)...................... 5.8
*73525 arthrography...................... RNE(For injection procedures, see27093-27094)
73530 during operative proceduresup to four studies................. 9.4
73532 each additional study.............. 1.8
73550 Femur (thigh), including onejoint.............................. 3.8
73560 Knee, limited...................... 2.7
73570 complete .......................... 4.0
73580 arthrography ...................... 9.1(For injection procedure, see27370)
73590 Tibia and fibula (leg), includingone joint ......................... 3.1
73600 Ankle, limited .................... 2.7
73610 complete .......................... 3.6
*73615 arthrography...................... RNE(For injection procedures, see27646)
73620 Foot, limited...................... 2.5
73630 complete........................... 3.4
73640 Foot and ankle..................... 5.9
73650 Os calcis (heel) .................. 2.7
73660 Toe(s)............................. 2.3
*73999 Unlisted procedure, lowerextremities........................ BR**
(7) Abdomen.
74000 Abdomen, single view (KUB)......... 2.6
74010 with additional oblique orcone view.......................... 3.9
74020 complete, includes decubitusand/or erect view.................. 5.1
(8) Gastrointestinal Tract.
74210 Pharynx and/or cerical esophagus... 5.4
74220 Esophagus.......................... 5.4
74230 Pharynx and/or esophagus,by cineradiography................. 7.4
*74242 Upper gastronintestinal tract,with or without KUB and withor without delayed films........... 9.1
*74243 limited upper gastrointestinaltract (e.g., recheck or followup study).......................... 6.4
74245 with small bowel, includesmultiple serial films, with orwithout fluoroscopy................ 11.0
74250 Small bowel, includesmultiple serial films with orwithout fluoroscopy or KUB,independent study.................. 8.5
*74260 Duodenography, hypotonic........... RNE
74270 Colon, barium enema ............... 7.5
74275 combined with air contrast......... 11.0
74280 air contrast (independentprocedure)......................... 8.9
74290 Cholecystography, oral............. 6.0
74291 repeat examination, samestudy.............................. 3.0
74300 Cholangiography operative.......... 7.6
*74305 post-operative (t-tube)............ *7.2(For biliary duct stone

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Section 447.3 - Neurology--Diagnostic Services

447.3 Neurology--Diagnostic Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7460 Neurology--Diagnostic

(b) The above cost center uses as the basis for the Standard Unit of Measure the applicable procedures from the Neuro-Muscular section of the Medicine Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies (RVS). Relative Value Units for unlisted, BR (By Report), and RNE (Relativity Not Established) procedures are to be reasonably estimated by qualified personnel. Because the California Medical Association is no longer publishing their Relative Value Studies booklet, the applicable procedures from the Neuro-Muscular section of the Medicine chapter are set forth below with the approval of CMA.

Unit

Value

(1) 95819 Electro-encephalogram (EEG), standard or portable,

same facility............................................ 20.0

(2) 95821 portable, to an alternate facility....................... 30.0

(3) 95822 sleep.................................................... 30.0

(4) 95823 physical or pharmacological, activation.................. 30.0

(5) 95824 cerebral death evaluation recording...................... BR

(6) 95826 Intra-cerebral (depth) EEG............................... BR

(7) 95827 all night sleep recording................................ BR

(8) 95860 Electromyography, one extremity and related paraspinal areas......................................... 20.0

(9) 95861 two extremities and related paraspinal areas............. 36.0

(10) 95863 three extremities and related paraspinal areas........... 44.0

(11) 95864 four extremities and related paraspinal areas............ 52.0

(12) 95867 cranial nerve supplied muscles, unilateral............... RNE

(13) 95868 bilateral................................................ RNE

(14) 95869 limited study of specific muscles, e.g., external and sphincter, thoracic spinal muscles, etc.................. BR
 

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete

Section 447.4 - Physical therapy services

447.4 Physical therapy services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7510 Physical Therapy

(1) The standard unit of measure will be the relative value units developed by the American Physical Therapy Association. Relative value units shall be counted during a patient visit for all cost center activities for which a charge is made. A patient visit is the occasion for service during which the resources of the physical therapy cost center are used. A visit is one appearance of a patient regardless of the number of evaluation, therapeutic, patient education activities performed during that appearance.

(2) The two major components of the relative value unit are: personnel time associated with the activity, and other direct and appropriate indirect department resources used in providing the activity. Fifteen minutes has been established as the least increment of time for which a unit of service (e.g., evaluation, therapeutic, or patient educational activity) can occur. The unit of service which requires the least amount of the physical therapy department's total resources is a modality. This activity is used to establish the basic relative value unit of 1.0. Since the basic relative value unit of 1.0 does not require the continuous attendance of physical therapy personnel, the initial unit value for those services that do require the continuous attendance of physical therapy personnel is adjusted upward. An additional .4 of a unit will be added to the initial increment for those activities requiring continuous attendance by physical therapy personnel. When subsequent 15-minute increments of service are provided, some of the initial direct and indirect costs do not recur or are reduced. Therefore, relative value units for subsequent increments of time are approximately 10 percent less than the initial unit value.

(3) The recording of 15-minute increments of service begins with the initiation of the evaluation, therapeutic, or patient educational activity. Although time may have been spent transporting the patient to the department or making entries in the medical record, RVU's are not counted for these activities. Patient transportation, treatment preparation and cleanup, and recordkeeping costs are incorporated in the weighting of the initial 15-minute increment of service and additional RVU's cannot be added for these activities. However, the time required to complete a separate formal report for patient evaluations or aftercare planning can be counted.

(4) Therapeutic or evaluation activities performed in the home shall have a unit value equivalent to that for the appropriate therapeutic or evaluation activity rendered plus an allowance for travel time to and from the home. Travel time for home visits is valued the same as those activities requiring continuous attendance by physical therapy personnel with the patient.
(b) RELATIVE VALUE UNITS
Initial Additional 1515 minutes (round toDescription minutes nearest 15 minutes)
(1) EVALUATION ACTIVITIES
Evaluation activities are assessments of patients' performance toassist in establishing diagnoses orto establish or reevaluatetreatment plans. 1.4 1.3
(2) THERAPEUTIC ACTIVITIES
(i) Modalities
A modality does not require thecontinuous attendance of physicaltherapy personnel during a therapeutics activity 1.0 0.9
(ii) Procedures
A procedure does require the continuousattendance of physical therapy personnelduring a therapeutic activity. 1.4 1.3
(iii) Hydrotherapy
Continuousattendance ofpersonnel
notrequired required
Extremity or Body Whirlpool 1.4 1.3 0.9
Hubbard Tank or Therapeutic Pool 2.5 1.3 0.9
Initial Additional 1515 minutes (round tominutes nearest 15minutes)
(3) PATIENT EDUCATIONAL ACTIVITIES
Patient educational activities are usedto instruct the patient or his attendant,family or their substitute in maintainingand improving the patient's condition. 1.4 1.3
(4) COMBINATION OF EVALUATION, THERAPEUTICOR PATIENT EDUCATIONAL ACTIVITIESMultiple evaluation, therapeutic, patienteducational activities performed duringa patient visit will be reported as acombination.
(i) Any number of modalities in combination 1.0 0.9
(ii) Any number of evaluation, therapeutic,or patient educational activities incombination 1.4 1.3
(iii) Hydrotherapy in combination withother activities:
Extremity or Body Whirlpool 1.4 1.3
Hubbard Tank or Therapeutic Pool 2.5 1.3
(5) HOME VISITS
A home visit is provided to an individualpatient in a setting other than the physicaltherapist's office or work facility. Thestandard unit of measure for home visitsincludes the number of relative value unitsfor the evaluation, therapeutic, or patienteducational activity and for travel time.
(i) Evaluation, Therapeutic, orEducational Activities 1.4 1.3
(ii) Travel Time
Travel time for home visits is the actualtime spent by physical therapy personnelgoing to and from the home. Travel timefor multiple home visits during a singletrip is calculated by dividing the totalnumber of relative value units for traveltime by the number of patients treatedduring that trip. 1.3 1.3
(6) GROUP ACTIVITIES
A group activity is the occasion forservice during which two or more patientssimultaneously receive a therapeutic,evaluation, or patient educationalactivity. Group activities will bereported by counting the number of RVU'sfor one patient participating in thegroup activity session, and adding 0.1RVU per session for each patientparticipating in the group activity. 1.3 1.3
(7) Notes
(i) For further explanation of how to use the relative value units seethe accompanying Schedule of Unit Values and Examples of RelativeValue Unit Computations for Combination Activities.
(ii) When multiple personnel are used during an entire activityperiod, additional 1.3 RVU's are recorded for each person for each15-minute increment.
(iii) The units of measure do not Include wound dressing, debridement,exercise or other activities performed in conjunction with hydrotherapy.
(iv) When computing an indiviudal's RVU's, the value should be roundedto the nearest one-tenth (e.g., 0.62 = 0.6, 0.68 = 0.7).
(c) SCHEDULE OF UNIT VALUES
UNIT VALUE TOTAL VALUES
Initial Additional
Description 15 15 30 45 60min. min. min. min. min.
(1) Evaluation Activities 1.4 1.3 2.7 4.0 5.3
(2) Therapeutic Activities
(i) Modalities 1.0 0.9 1.9 2.8 3.7
(ii) Procedures 1.4 1.3 2.7 4.0 5.3
UNIT VALUE TOTAL VALUES
Initial Additional
Description 15 15 30 45 60min. min. min. min. min.

(iii) Hydrotherapy
Extremity or Body
Whirlpool
Continuous attendanceof personnelrequired 1.4 1.3 2.7 4.0 5.3
not required 1.4 0.9 2.3 3.2 4.1
Hubbard Tank orTherapeutic Pool
Continuous attendanceof personnel
required 2.5 1.3 3.8 5.1 6.4
not required 2.5 0.9 3.4 4.3 5.2
(3) Patient EducationalActivities 1.4 1.3 2.7 4.0 5.3
(4) Combination of Evaluation,Therapeutic, or PatientEducational Activities
(i) Any Number of Modalitiesin Combination 1.0 0.9 1.9 2.8 3.7
(ii) Any Number of Evaluation,Therapeutic, or PatientEducational Activitiesin Combination 1.4 1.3 2.7 4.0 5.3
(iii) Hydrotherapy inCombination withOther ActivitiesExtremity or BodyWhirlpool 1.4 1.3 2.7 4.0 5.3
Hubbard Tank orTherapeutic Pool 2.5 1.3 3.8 5.1 6.4
(5) Home Visits
(i) Evaluation, Therapeutic,or Patient EducationalActivities 1.4 1.3 2.7 4.0 5.3
(ii) Travel Time 1.3 1.3 2.6 3.9 5.2
(6) Group Activities(total RVU's plus 0.1 persession for each patient) 1.3 1.3 2.6 3.9 5.2Note: Activities that exceed 60 minutes are recorded by adding theappropriate values from the "additional 15 minutes" column.
(d) EXAMPLES OF RELATIVE VALUE UNIT COMPUTATIONS FOR COMBINATIONACTIVITIES
(1) Description Calculations RVU's
(1) MODALITIES
A patient is in the department for 60 minutes.The patient waits 30 minutes before receiving30 minutes of hot packs and cervicaltraction to the neck. 1.0 + 0.9 = 1.9
(2) PROCEDURES
Therapeutic exercise to the right legand gait training for 1.4 + 1.3 + 1.3 = 4.0
45 minutes.
(3) EVALUATION AND MODALITIES/PROCEDURES
Evaluation, hot pack, ultrasound,and massage to the left shoulderfor 75 minutes. 1.4 + 1.3 + 1.3 +
1.3 + 1.3 = 6.6
(4) HYDROTHERAPY
(i) Extremity whirlpool, not requiringcontinuous attendance of physicaltherapy personnel, 30 minutes. 1.4 + 0.9 = 2.3
(ii) Therapeutic pool, requiring continuousattendance of physical therapypersonnel, 45 minutes. 1.4 + 1.3 + 1.3 = 4.0
(5) HYDROTHERAPY COMBINATIONS
(i) Extremity whirlpool massage andexercise to the left arm for 60minutes. 1.4 + 1.3 + 1.3
+ 1.3 = 5.3
(ii) Body whirlpool and exercise to bothlegs and back for 60 minutes. 1.4 + 1.3 + 1.3
+ 1.3 = 5.3
(iii) Hubbard tank and burn debridementto upper torso for 60 minutes with onestaff member required; 2.5 + 1.3 + 1.3
+ 1.3 = 6.4
with two staff members required. (2.5 + 1.3 + 1.3 +
1.3) + (1.3 + 1.3 +
1.3 + 1.3) = 11.6
(6) HOME VISIT
(i) A visit is made to a patient's homeand 25 minutes of diathermy is provided.A visit is then made to another patient'shome and 35 minutes of gait trainingis provided. Travel time to and from thehospital as well as between the twohomes is 45 minutes.
(ii) The RVU's for travel time per homevisit are the total number of RVU'sfor travel time divided by the totalnumber of home visits. 1.3 + 1.3 +
1.3 = 3.9
3.9 -2.0 = 1.95
or 2.0 2.0
(iii) First visit: Diathermy treatmentfor 25 minutes. 1.4 + 1.3 = 2.7
Total RVU's for first 2.0 + 2.7 = 4.7
home visit.
(iv) Second visit: Gait training for35 minutes. 1.4 + 1.3 = 2.7
Total RVU's for second 2.0 + 2.7 = 4.7home visit
(7) GROUP ACTIVITIES
(i) Ten patients received exerciseinstruction and patient education. Theactivity session was 35 minutes inDuration.
(ii) One staff member required. (1.3 + 1.3) +
(0.1 x 10) = 3.6
(Average RVU's
per patient =
0.36 or 0.4
(iii) Two staff members required. (1.3 + 1.3) +
(1.3 + 1.3) +
(1.3 + 1.3) = 6.2
(10 x 0.1)
(Average RVU's
per patient =
0.62 or 0.6)

Effective Date: 
Tuesday, December 23, 1980
Doc Status: 
Complete

Section 447.5 - Occupational Therapy Services

447.5 Occupational therapy services.
(a) ACCOUNT NUMBER COST CENTER TITLE
7530 Occupational Therapy
(1) The standard unit of measure will be the relative value units developed by the American Occupational Therapy Association. Relative value units should be counted during a patient visit for all assessment, treatment or other activities which use the resources of the occupational therapy department, and for which a charge is made. Fifteen minutes is the smallest increment of time for which a unit of service should occur. After the initial 15 minutes, patient contact for less than 15 minutes should be rounded to the nearest whole 15-minute period.
(2) For patient groups of two or more, the appropriate relative value units listed in the schedule should be counted for each patient in the group. Different codes should be used to indicate the same treatment given to different size groups.
(3) Since a charge for only one treatment for a 15-minute period can be made, concurrent or combination treatments should be handled by selecting the most significant or longest treatment determined by the therapist.
(4) Occupational therapy services provided in the home will have a unit value equivalent to that shown in the schedule for the service provided, plus the applicable unit value for travel time to and from the home.
(5) Relative value units for unlisted procedures should be reasonably estimated on the basis of other comparable procedures, or estimated by qualified personnel. If your facility has a standard set of treatments that all patients receive unique to your facililty, using the system as a guide, relative value units should be developed.
(6) The system includes several definitions of activities not listed on the Relative Value Schedule, as the schedule is designed only for direct treatment.
RVU's per 15
minutes Patient Group
Categories

9 or
Code 1 2-4 5-8 more
number* Service category pt. pts. pts. pts.

(b) Occupational Therapy Assessment.

98001-03 (1) Screening 11 5.5 3.3

98004 (2) Patient Related Consultation 14

(3) Evaluation

98005-06 (i) Independent Living/Daily
Living Skills and
Performance 18 9.0

98010-00 (ii) Sensorimotor Skill and
Performance Components 21 10.5

98015-16 (iii) Cognitive Skill and Performance
Components 20 10.0

98020-21 (iv) Psychosocial Skill and
Performance Components 18 9.0

98025-26 (v) Therapeutic Adaptations 19

98030-32 (vi) Specialized Evaluation 23 11.5 6.9

(4) Reassessment 18 9.0

(c) Occupational Therapy Treatment.

(1) Independent Living/Daily Living
Skills and Performance

98040-42 (i) Physical Daily Living Skills 13 6.5 3.9

98045-47 (ii) Psychosocial/Emotional Daily
Living Skills 13 6.5 3.9

(iii) Work

98050-52 (a) Homemaking 15 7.5 4.5

98055-57 (b) Child Care/Parenting 18 9.0 5.4

98060-62 (c) Employment Preparation 19 9.5 5.7

98065-67 (iv) Play/Leisure 14 7.0 4.2

(2) Sensorimotor Components

(i) Neuromuscular

98070 (a) Reflex Integration 18

98075-78 (b) Range of Motion 13 6.5 3.9 1.3

98080-83 (c) Gross and Fine 13 6.5 3.9 1.3
Coordination

98085-88 (d) Strength and Endurance 13 6.5 3.9 1.3

98090-92 (ii) Sensory Integration 16 8.0 4.8

(3) Cognitive Components

98095-98 (i) Orientation 10 5.0 3.0 1.0

98100-01 (ii) Conceptualization/Comprehension 14 7.0

98105-06 (iii) Cognitive Integration 14 7.0

(4) Psychosocial Components

98110-13 (i) Self Management 14 7.0 4.2 1.4

98115-16 (ii) Dyadic Interaction 14 7.0

98120-23 (iii) Group Interaction 10 5.0 3.0 1.0

(5) Therapeutic Adaptation

98125 (i) Orthotics 20

98130-31 (ii) Prosthetics 16 8.0

98135-36 (iii) Assistive/Adaptive 16 8.0

98140-43 (6) Prevention 13 6.5 3.9 1.3

98145 (d) Patient/Client-Related 14
Conferences

98150-53 (e) Travel: Patient 12 6.0 3.6 1.2
Treatment Related
(f) Only one code number may be used for a given category. Thus, where a series of code numbers are listed, each code number in the series is to be used for a different patient group category. For example, code numbers 98001 through 98003 are given for screening: 98001 would be used for screening one patient, 98002 for screening a group of two to five patients, and 98003 for screening a group of six to eight patients.

 

Doc Status: 
Complete

Part 448 - Sampling Specifications

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

Section 448.1 - Specifications for cost reporting periods beginning in 1980

Section 448.1 Specifications for cost reporting periods beginning in 1980.

(a) The cost allocation statistics and required Standard Units of Measure, except inpatient days, may be estimated using statistical sampling instead of taking complete counts. Statistical sampling is most appropriate for those SUM's and cost allocation statistics which can be obtained from a physical record of the transaction or procedure. For example, the laundry and linen cost center might keep a log of the number of pounds processed daily. At the end of the year or at convenient intervals through the year, a random sample of days can be taken from the log and an estimate of the total pounds processed for the year can be made. It may also be possible to use sampling techniques for those transactions for which no record is kept. In this case, however, the procedures are likely to be more complex and costly.

(b) If statistical sampling is to be used, it will be necessary to adhere strictly to the appropriate procedures. Subsequent audits may be conducted by fiscal intermediaries. At some time in the future, the Health Care Financing Administration (HCFA) will publish procedures that will have wide applicability to a variety of items and situations. If the published procedures are not applicable or it is desired to use alternative methods, the hospital must be prepared to demonstrate that its plan adheres to the principle of scientific statistical sampling.

(c) Until such time as the Health Care Financing Administration (HCFA) publishes the necessary procedures mentioned above, the following methodology must be used:

(1) A minimum of eight calendar weeks will be selected each year for the accumulation of data.

(2) These eight weeks will be representative of the full year. In order to achieve this, the hospital will select a two-week block (14 consecutive days) within each fiscal quarter for the collection of data.

(3) The same two-week block need not be used for all statistics.

(4) During the testing period, actual counting, weighting, etc. will be done for all shifts involved in the particular area.

(5) Periods of "unusual" circumstances should be avoided as test weeks. The principle of representative samples is the ultimate goal.
 

Doc Status: 
Complete