Worksheet S-10

Return to Profile
Filing History
FORM CMS-2552-10
INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV 18

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
HOSPITAL UNCOMPENSATED AND INDIGENT CARE DATA Provider CCN: 420004
PERIOD:
FROM 07/01/2021
TO 06/30/2022
WORKSHEET S-10
Uncompensated and indigent care compensation
1 Cost to charge ratio (Worksheet C, Part I, line 202, column 3, divided by line 202, column 8) ### 1
Medicaid (see instructions for each line)
2 Net revenue from Medicaid ### 2
3 Did you receive DSH or supplemental payments from Medicaid? ### 3
4 If line 3 is yes, does line 2 include all DSH and/or supplemental payments from Medicaid? ### 4
5 If line 4 is no, enter DSH and/or supplemental payments from Medicaid? ### 5
6 Medicaid charges ### 6
7 Medicaid cost (line 1 times line 6) ### 7
8 Difference between net revenue and costs for Medicaid program (see instructions) ### 8
Children's Health Insurance Program (CHIP) (see instructions for each line)
9 Net revenue from stand-alone CHIP 9
10 Stand-alone CHIP charges 10
11 Stand-alone CHIP cost (line 1 times line 10) 11
12 Difference between net revenue and costs for stand-alone CHIP (see instructions) 12
Other state or local government indigent care program (see instructions for each line)
13 Net revenue from state or local indigent care program (not included on lines 2, 5 or 9) 13
14 Charges for patients covered under state or local indigent care program (not included in lines 6 or 10) 14
15 State or local indigent care program cost (line 1 times line 14) 15
16 Difference between net revenue and costs for state or local indigent care program (see instructions) 16
 
Grants, donations and total unreimbursed cost for Medicaid, CHIP and state/local indigent care programs (see instructions for each line)
17 Private grants, donations, or endowment income restricted to funding charity care 17
18 Government grants, appropriations or transfers for support of hospital operations 18
19 Total unreimbursed cost for Medicaid, CHIP and state and local indigent care programs (sum of lines 8, 12 and 16) ### 19
 
Uncompensated care cost (see instructions for each line)
  Uninsured patients Insured patients Total (col. 1 + col. 2)  
1 2 3
20 Charity care charges and uninsured discounts (see instructions) ### ### 20
21 Cost of patients approved for charity care and uninsured discounts (see instructions) ### ### 21
22 Payments received from patients for amounts previously written off as charity care 22
23 Cost of charity care (see instructions) ### ### 23
24 Does the amount in line 20, col. 2, include charges for patient days beyond a length of stay limit imposed on patients covered by Medicaid or other indigent care program? ### 24
25 If line 24 is yes, enter charges for patient days beyond the indigent care program's length of stay limit (see instructions) 25
25.01 Charges for insured patients' liability (see instructions) 25.01
26 Bad debt amount (see instructions) ### 26
27 Medicare reimbursable bad debts (see instructions) ### 27
27.01 Medicare allowable bad debts (see instructions) ### 27.01
28 Non-Medicare bad debt amount (see instructions) ### 28
29 Cost of non-Medicare and non-reimbursable Medicare bad debt amounts (see instructions) ### 29
30 Cost of uncompensated care (line 23 col. 3 plus line 29) ### 30
31 Total unreimbursed and uncompensated care cost (line 19 plus line 30) ### 31
 
FORM CMS-2552-10 (12-2022) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, §4012)
03-18   Rev. 14