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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