Worksheet D-1 Part I

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
COMPUTATION OF INPATIENT OPERATING COST Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
 WORKSHEET D-1, PART I
- Select other programs and provider types available
PART I - ALL PROVIDER COMPONENTS
INPATIENT DAYS
1 Inpatient days (including private room days and swing-bed days, excluding newborn) ### 1
2 Inpatient days (including private room days, excluding swing-bed and newborn days) ### 2
3 Private room days (excluding swing-bed and observation bed days). If you have only private room days, do not complete this line. 3
4 Semi-private room days (excluding swing-bed and observation bed days) ### 4
5 Total swing-bed SNF type inpatient days (including private room days) through December 31 of the cost reporting period 5
6 Total swing-bed SNF type inpatient days (including private room days) after December 31 of the cost reporting period (if calendar year, enter 0 on this line) 6
7 Total swing-bed NF type inpatient days (including private room days) through December 31 of the cost reporting period 7
8 Total swing-bed NF type inpatient days (including private room days) after December 31 of the cost reporting period (if calendar year, enter 0 on this line) 8
9 Total inpatient days including private room days applicable to the Program (excluding swing-bed and newborn days) (see instructions) ### 9
10 Swing-bed SNF type inpatient days applicable to title XVIII only (including private room days) through December 31 of the cost reporting period (see instructions). 10
11 Swing-bed SNF type inpatient days applicable to title XVIII only (including private room days) after December 31 of the cost reporting period (if calendar year, enter 0 on this line) 11
12 Swing-bed NF type inpatient days applicable to titles V or XIX only (including private room days) through December 31 of the cost reporting period. 12
13 Swing-bed NF type inpatient days applicable to titles V or XIX only (including private room days) after December 31 of the cost reporting period (if calendar year, enter 0 on this line) 13
14 Medically necessary private room days applicable to the Program (excluding swing-bed days) 14
15 Total nursery days (title V or XIX only) 15
16 Nursery days (title V or XIX only) 16
SWING BED ADJUSTMENT
17 Medicare rate for swing-bed SNF services applicable to services through December 31 of the cost reporting period 17
18 Medicare rate for swing-bed SNF services applicable to services after December 31 of the cost reporting period 18
19 Medicaid rate for swing-bed NF services applicable to services through December 31 of the cost reporting period 19
20 Medicaid rate for swing-bed NF services applicable to services after December 31 of the cost reporting period 20
21 Total general inpatient routine service cost (see instructions) ### 21
22 Swing-bed cost applicable to SNF type services through December 31 of the cost reporting period (line 5 x line 17) 22
23 Swing-bed cost applicable to SNF type services after December 31 of the cost reporting period (line 6 x line 18) 23
24 Swing-bed cost applicable to NF type services through December 31 of the cost reporting period (line 7 x line 19) 24
25 Swing-bed cost applicable to NF type services after December 31 of the cost reporting period (line 8 x line 20) 25
26 Total swing-bed cost (see instructions) 26
27 General inpatient routine service cost net of swing-bed cost (line 21 minus line 26) ### 27
PRIVATE ROOM DIFFERENTIAL ADJUSTMENT
28 General inpatient routine service charges (excluding swing-bed and observation bed charges) 28
29 Private room charges (excluding swing-bed charges) 29
30 Semi-private room charges (excluding swing-bed charges) 30
31 General inpatient routine service cost/charge ratio (line 27 ÷ line 28) 31
32 Average private room per diem charge (line 29 ÷ line 3) 32
33 Average semi-private room per diem charge (line 30 ÷ line 4) 33
34 Average per diem private room charge differential (line 32 minus line 33) (see instructions) 34
35 Average per diem private room cost differential (line 34 x line 31) 35
36 Private room cost differential adjustment (line 3 x line 35) 36
37 General inpatient routine service cost net of swing-bed cost and private room cost differential (line 27 minus line 36) ### 37
FORM CMS-2552-10 (07-2023) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTIONS 4025.1)
07-23     Rev. 21