Worksheet B-1

Return to Profile
Filing History
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.

The data in this report have been replaced because you do not own it or are not logged in.

Add to Cart
COST ALLOCATION - STATISTICAL BASIS Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
 WORKSHEET B-1
COST CENTER DESCRIPTIONS Capital Related Cost Employee Benefits Department (gross salaries) Reconciliation Administrative & General (accum. cost) Maintenance & Repairs (square feet) Operation of Plant (square feet) Laundry & Linen Service (pounds of laundry) Housekeeping (hours of service) Dietary (meals served) Cafeteria (meals served) Maintenance of Personnel (number housed) Nursing Administration (direct nurs. hrs) Central Services & Supply (costed requis.) Pharmacy (costed requis.) Medical Records & Library (time spent) Social Service (time spent) Other General Service (specify) Non- Physician Anesthetists (asgnd time) Nursing Program (assigned time) Interns & Residents Paramedical Education (assigned time) Subtotal Intern & Resident cost & post stepdown adjustments Total  
Bldgs. & Fixtures (square feet) Movable Equipment (dollar value) Salary and Fringes (assigned time) Program Costs (assigned time)
1 2 4 5A 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
GENERAL SERVICE COST CENTERS                                                      
1 Capital Related Costs-Buildings and Fixtures ###     1
2 Capital Related Costs-Movable Equipment ###   2
4 Employee Benefits Department 4
5 Administrative and General 5
5.05 Other Administrative & General ### ### ### ### 5.05
5.30 Admitting ### ### ### 5.30
6 Maintenance and Repairs 6
7 Operation of Plant ### ### ### ### 7
8 Laundry and Linen Service ### ### ### ### 8
9 Housekeeping ### ### ### ### ### 9
10 Dietary ### ### ### ### ### 10
11 Cafeteria ### ### 11
12 Maintenance of Personnel 12
13 Nursing Administration ### ### ### ### ### ### ### ### 13
14 Central Services and Supply ### ### ### ### ### ### ### ### 14
15 Pharmacy ### ### ### ### ### ### ### 15
16 Medical Records & Medical Records Library ### ### ### ### ### ### ### 16
17 Social Service ### ### ### ### ### ### 17
18 Other General Service (specify) 18
19 Nonphysician Anesthetists 19
20 Nursing Program 20
21 Intern & Res. Service-Salary & Fringes (Approved) ### ### ### ### ### 21
22 Intern & Res. Other Program Costs (Approved) ###   ### 22
23 Paramedical Education Program (specify) ### ### ### ### ###       ### 23
INPATIENT ROUTINE SERVICE COST CENTERS                                                      
30 Adults and Pediatrics (General Routine Care) ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###       30
31 Intensive Care Unit ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###       31
32 Coronary Care Unit       32
33 Burn Intensive Care Unit       33
34 Surgical Intensive Care Unit       34
35 Other Special Care Unit (specify) NEONATAL ICU ### ### ### ### ### ### ### ### ### ### ### ### ### ###       35
40 Subprovider IPF ### ### ### ### ### ### ### ### ### ### ### ### ### ###       40
41 Subprovider IRF       41
42 Subprovider (specify)       42
43 Nursery       43
44 Skilled Nursing Facility       44
45 Nursing Facility       45
46 Other Long Term Care       46
ANCILLARY SERVICE COST CENTERS                                                      
50 Operating Room ### ### ### ### ### ### ### ### ### ### ###       50
51 Recovery Room ### ### ### ### ### ### ### ### ### ###       51
52 Labor Room and Delivery Room ### ### ### ### ### ### ### ### ### ### ### ###       52
53 Anesthesiology ### ### ### ### ### ### ### ### ### ### ###       53
54 Radiology-Diagnostic ### ### ### ### ### ### ### ### ### ### ###       54
55 Radiology-Therapeutic ### ### ### ### ### ### ### ### ### ### ### ###       55
56 Radioisotope ### ### ### ### ### ### ### ### ### ### ###       56
57 Computed Tomography (CT) Scan       57
58 Magnetic Resonance Imaging (MRI)       58
59 Cardiac Catheterization ### ### ### ### ### ### ### ### ### ### ### ###       59
60 Laboratory ### ### ### ### ### ### ### ### ### ### ###       60
61 PBP Clinical Laboratory Services-Program Only                                                   61
62 Whole Blood & Packed Red Blood Cells       62
63 Blood Storing, Processing, & Trans.       63
64 Intravenous Therapy       64
65 Respiratory Therapy ### ### ### ### ### ### ### ###       65
66 Physical Therapy ### ### ### ### ### ### ### ### ###       66
67 Occupational Therapy ### ### ### ### ### ### ### ###       67
68 Speech Pathology ### ### ### ### ### ### ### ###       68
69 Electrocardiology ### ### ### ### ### ### ### ### ### ### ### ###       69
70 Electroencephalography ### ### ### ### ### ### ### ### ### ### ###       70
71 Medical Supplies Charged to Patients ### ### ###       71
72 Implantable Devices Charged to Patients ### ### ###       72
73 Drugs Charged to Patients ### ### ### ### ###       73
74 Renal Dialysis ### ### ### ### ### ### ### ### ### ### ###       74
75 ASC (Non-Distinct Part)       75
76 Other Ancillary (specify)       76
76.30 Other Ancillary Cost Centers ### ### ### ### ### ### ### ### ### ### ### ###       76.30
77 Allogeneic HSCT Acquisition       77
78 CAR T-Cell Immunotherapy       78
OUTPATIENT SERVICE COST CENTERS                                                      
88 Rural Health Clinic (RHC)       88
89 Federally Qualified Health Center (FQHC)       89
90 Clinic ### ### ### ### ### ### ### ### ### ### ### ### ###       90
91 Emergency ### ### ### ### ### ### ### ### ### ### ### ###       91
92 Observation Beds (Non-Distinct Part)       92
92.01 Observation Beds (Distinct Part)       92.01
93 Other Outpatient Service (specify)       93
93.99 Partial Hospitalization Program (specify)       93.99
OTHER REIMBURSABLE COST CENTERS                                                      
94 Home Program Dialysis       94
95 Ambulance Services       95
96 Durable Medical Equipment-Rented       96
97 Durable Medical Equipment-Sold       97
98 Other Reimbursable (specify)       98
99 Outpatient Rehabilitation Provider (specify)       99
100 Intern-Resident Service (not appvd. tchng. prgm.)       100
101 Home Health Agency       101
102 Opioid Treatment Program       102
SPECIAL PURPOSE COST CENTERS                                                      
105 Kidney Acquisition ### ### ### ### ### ### ### ###       105
106 Heart Acquisition ### ### ### ### ### ### ### ###       106
107 Liver Acquisition ### ### ### ### ### ### ### ###       107
108 Lung Acquisition ### ### ### ### ### ### ### ###       108
109 Pancreas Acquisition ### ### ###       109
110 Intestinal Acquisition       110
111 Islet Acquisition       111
112 Other Organ Acquisition (specify) ### ###       112
115 Ambulatory Surgical Center (Distinct Part)       115
116 Hospice       116
117 Other Special Purpose (specify)       117
118 SUBTOTALS (sum of lines 1 through 117) ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###       118
NONREIMBURSABLE COST CENTERS                                                      
190 Gift, Flower, Coffee Shop, & Canteen ###       190
191 Research       191
192 Physicians' Private Offices ### ### ### ### ### ### ###       192
193 Nonpaid Workers       193
194 Other Nonreimbursable (specify) ### ### ### ### ### ###       194
200 Cross foot adjustments                                                     200
201 Negative cost centers                                                     201
202 Cost to be allocated (per Worksheet B, Part I) ### ###   ### ### ### ### ### ### ### ### ### ### ### ### ### ###       202
203 Unit cost multiplier (Worksheet B, Part I) ### ###   ### ### ### ### ### ### ### ### ### ### ### ### ### ###       203
204 Cost to be allocated (per Worksheet B, Part II)       ### ### ### ### ### ### ### ### ### ### ### ### ### ###       204
205 Unit cost multiplier (Worksheet B, Part II)       ### ### ### ### ### ### ### ### ### ### ### ### ### ###       205
206 NAHE adjustment amount to be allocated (per Wkst. B-2)                                                 206
207 NAHE unit cost multiplier (Wkst. D, Parts III and IV)                                                 207
FORM CMS-2552-10 (12-2022) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 4020)
12-22   Rev. 18