Worksheet D Part III

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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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APPORTIONMENT OF INPATIENT ROUTINE SERVICE OTHER PASS THROUGH COSTS Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
 WORKSHEET D, PART III
Medicare -Title XVIII - Hospital
  Nursing Program Post Shutdown Adjustments Nursing Program Allied Health Post Shutdown Adjustments Allied Health Costs All Other Medical Education Cost Swing-Bed Adjustment Amount (see instructions) Total Costs (sum of cols. 1, 2 and 3, minus col. 4) Total Patient Days Per Diem (col. 5 ÷ col. 6) Inpatient Program Days Inpatient Program Pass-Through Cost (col. 7 x col. 8)  
(A) Cost Center Description 1A 1 2A 2 3 4 5 6 7 8 9
INPATIENT ROUTINE SERVICE COST CENTERS                    
30 Adults & 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 (Other)   42
43 Nursery   43
44 Skilled Nursing Facility   44
45 Nursing Facility   45
200 Total (sum of lines 30-199) ###   ### ###   ### ### 200
(A) Worksheet A line numbers
FORM CMS-2552-10 (03-2023) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4024.3)
03-23   Rev. 19