Worksheet A-8-2

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FORM CMS-2552-10
INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV 1

MEDICAL UNIVERSITY OF SOUTH CAROLINA - CHARLESTON, SC
Cost report status - As Submitted
[Record Code 741780 - 2010]
This is a prior filing for this period.

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PROVIDER-BASED PHYSICIANS ADJUSTMENTS Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
 WORKSHEET A-8-2
  Wkst. A Line # Cost Center/ Physician Identifier Total Remuneration Professional Component Provider Component RCE Amount Physician/ Provider Component Hours Unadjusted RCE Limit 5 Percent of Unadjusted RCE Limit  
1 2 3 4 5 6 7 8 9
1 1
2 ### ### ### ### ### ### ### ### 2
3 ### ### ### ### ### ### ### ### 3
4 ### ### ### ### ### ### ### ### 4
5 ### ### ### ### ### ### ### ### 5
6 ### ### ### ### ### ### ### ### 6
7 ### ### ### ### ### ### ### ### 7
8 ### ### ### ### ### ### ### ### 8
9 ### ### ### ### ### ### ### ### 9
10 ### ### ### ### ### ### ### ### 10
11 ### ### ### ### ### ### ### ### 11
12 ### ### ### ### ### ### ### ### ###
13 ### ### ### ### ### ### ### ### ###
14 ### ### ### ###
15 ### ### ### ### ### ### ### ### ###
16 ### ### ### ### ### ### ### ### ###
17 ### ### ### ### ### ### ### ### ###
18 ### ### ### ### ### ### ### ### ###
19 ### ### ### ### ### ### ### ### ###
200 TOTAL   ### ###   ### ### ### 200
                     
                     
  Wkst. A Line # Cost Center / Physician Identifier Cost of Memberships & Continuing Education Provider Component Share of col. 12 Physician Cost of Malpractice Insurance Provider Component Share of col. 14 Adjusted RCE Limit RCE Disallowance Adjustment  
  10 11 12 13 14 15 16 17 18  
1 1
2 ### ### ### 2
3 ### ### ### ### ### 3
4 ### ### ### ### ### 4
5 ### ### ### 5
6 ### ### ### ### ### 6
7 ### ### ### ### ### 7
8 ### ### ### 8
9 ### ### ### 9
10 ### ### ### ### ### 10
11 ### ### ### 11
12 ### ### ### ### ### ###
13 ### ### ### ### ### ###
14 ### ### ###
15 ### ### ### ###
16 ### ### ### ### ### ###
17 ### ### ### ###
18 ### ### ### ###
19 ### ### ### ### ### ###
200 TOTAL   ### ### ### 200
                     
FORM CMS-2552-9 (10/2012) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 4018)
10-12   Rev. 3