SNF MINIMUM DATA SET
10/1/99
Table I: Type of Control: (S13)
FREESTANDINGSNFsHOSPITAL BASED SNFs
VoluntaryVoluntary
1 = Church1 = Church
2 = Other2 = Other
PropietaryPropietary
3 = Individual3 = Individual
4 = Corporation4 = Corportion
5 = Partnership5 = Partnership
6 = Other6 = Other
GovernmentGovernment
7 = Federal7 = Federal
8 = City - County8 = City-County
9 = County9 = County
10 = State 10 = State
11 = Hospital District 11 = Hospital District
12= City 12 = City
13 = Other 13 = Other
Table II: Type of Freestanding SNF (S14)
0 = HCFA Form 2540S-97 (Reimbursed under Prospective Payment System)
1 = Entirely Participating SNF *
2 = Partially Participating SNF *
3 = SNF Unit of Domiciliary Institution *
4 = SNF Unit of Rehabilitation Center *
5 =Other *
* = HCFA Form 2540-96
SNF MINIMUM DATA SET
10/1/99
Table III: FIPS State Codes (S16)
01 = Alabama 02 = Alaska 04 = Arizona
05 = Arkansas 06 = California 08 = Colorado
09 = Connecticut 10 = Delaware 11 = Washington, D. C.
12 = Florida 13 = Georgia 15 = Hawaii
16 = Idaho 17 = Illinois 18 = Indiana
19 = Iowa 20 = Kansas 21 = Kentucky
22 = Louisiana 23 = Maine 24 = Maryland
25 = Massachusetts 26 = Michigan 27 = Minnesota
28 = Mississippi 29 = Missouri 30 = Montana
31 = Nebraska 32 = Nevada 33 = New Hampshire
34 = New Jersey 35 = New Mexico 36 = New York
37 = North Carolina 38 = North Dakota 39 = Ohio
40 = Oklahoma 41 = Oregon 42 = Pennsylvania
43 = Puerto Rico 44 = Rhode Island 45 = South Carolina
46 = South Dakota 47 = Tennessee 48 = Texas
49 = Utah 50 = Vermont 51 = Virginia
53 = Washington 54 = West Virginia 55 = Wisconsin
56 = Wyoming 99 = Other
Table IV: SSA State Codes (S18) (The first two digits of the Medicare Provider Number)
01 = Alabama 02 = Alaska 03 = Arizona
04 = Arkansas 05 = California 06 = Colorado
07 = Connecticut 08 = Delaware 09 = Washington, D. C.
10 = Florida 11 = Georgia 12 = Hawaii
13 = Idaho 14 = Illinois 15 = Indiana
16 = Iowa 17 = Kansas 18 = Kentucky
19 = Louisiana 20 = Maine 21 = Maryland
22 = Massachusetts 23 = Michigan 24 = Minnesota
25 = Mississippi 26 = Missouri 27 = Montana
28 = Nebraska 29 = Nevada 30 = New Hampshire
31 = New Jersey 32 = New Mexico 33 = New York
34 = North Carolina 35 = North Dakota 36 = Ohio
37 = Oklahoma 38 = Oregon 39 = Pennsylvania
40 = Puerto Rico 41 = Rhode Island 42 = South Carolina
43 = South Dakota 44 = Tennessee 45 = Texas
46 = Utah 47 = Vermont 49 = Virginia
50 = Washington 51 = West Virginia 52 = Wisconsin
53 = Wyoming 99 = Other
SNF MINIMUM DATA SET
10/1/99
Table V: Cost Report Status (S21)
1 = As Submitted
2 = Settled Without Audit
3 = Settled With Audit
4 = Reopened
Table VI: Type of Cost Report (S22)
2540-96 2540S-97
L = Low Medicare Utilization * L = Low Medicare Utilization *
N = No Medicare Utilization * F = Full Cost Report
F = Full Cost Report
A = All-Inclusive *
Table VII: Census Divisions (S23)
0 = National
1 = New England
2 = Middle Atlantic
3 = South Atlantic
4 = East North Central
5 = East South Central
6 = West North Central
7 = West South Central
8 = Mountain
9 = Pacific
Table VIII: HCFA Regions (S24)
1 = Boston
2 = New York
3 = Philadelphia
4 = Atlanta
5 = Chicago
6 = Dallas
7 = Kansas City
8 = Denver
9 = San Francisco
10 = Seattle
* For No Medicare Utilization cost reports, only provider identifying data is available. In addition to the provider identifying data, the following fields of data are available for Low Medicare Utilization reports; S26, S38, S43, S46, S50, S336, S337, S348, S349, S364, S365, S375, S376, and S405. All Inclusive cost reports that cannot be processed through the automated system as full cost reports, are received as Low Medicare Utilization reports.
SNF MINIMUM DATA SET
10/1/99
FOR FREE-STANDING AND HOSPITAL BASED COST REPORTS FOR
COST REPORTING PERIODS ENDING ON OR AFTER SEPTEMBER 30, 1996
TABLE OF CONTENTS
Identifying and Informational Data 1
Statistical and Summary Utilization Data 2,3
Total Costs 3,4
Total Costs Before Cost Allocation 4
General Service Costs Allocated to SNF-Participating 5
Total Costs After Cost Allocation 6
Cost Allocation Statistical Bases - HCFA 2540S-876
Old Capital-Related Costs Available for Pass Through 7, 8
New Capital-Related Costs Available for Pass Through 8
Old Capital-Related Costs Allocated to SNF-Participating8
New Capital-Related Costs Allocated to SNF - Participating9
Total Facility Ancillary Charges 9
Ratio of Cost to Charges for Ancillary and Outpatient10
Medicare Part A Inpatient Ancillary Costs and Charges11
Medicare Part B Inpatient Ancillary Costs and Charges 12
Computation of Inpatient Routine Costs in Total and for Medicare 13
Medicare Part A Inpatient Settlement Summary 13, 14
Medicare Part B Inpatient Settlement Summary 14
Medicare Part A PPS Settlement Summary15
Medicare Part B PPS Settlement Summary15
Financial Data 16
Patient Revenues 16
Facility Revenues and Expenses 16
SNF Wage Index Information17 - 19
Tables 20 - 22