MEDICAID & MEDICARE COST REPORT
2012 STATISTICAL REQUIREMENTS
Dear Nursing Home Administrator:
The attached logs and/or schedules will assist your Facility in accumulating the necessary statistics and information to complete the 2012 RHCF-4 Medicaid Cost Report and Medicare Cost Report.
It is suggested that you reproduce this entire booklet and distribute the individual logs and/or schedules to the various department heads, consultants and/or responsible parties who will have the information to complete them.
These logs and/or schedules should be completed and submitted to our office no later than March15, 2013 to allow for appropriate time to complete the Medicaid and Medicare Cost Reports by the filing deadlines.
Additional excel copies can be found and downloaded from our website, by clicking on “Helpful Downloads”.
If you have any questions and/or need clarification, do not hesitate to contact us.
Respectfully yours,
ABBATE DEMARINIS, LLP
CONTENTS/GENERAL INSTRUCTIONS
I.PATIENT CARE AND INTENSITY STATISTICS
1.Patients Admitted During Report Period
To identify where patients were admitted from their primary payor.
2.Patients Discharged During Report Period
To identify where a patient was discharged to and their length of stay.
3,4,5. Log of Patients Under Care Last Day of Report Period
There are at least sixteen classifications to be made for all patients in the
Facility as of the last day of the period. These classifications are as follows:
1. Patient Age & Sex
2. PatientsLength of Stay
3. Primary Payor (Private, Medicare, Medicaid)
4. Patient Origin by County
To effectively accumulate this information, list all patients in the Facility as of
December 31 and indicate the various required information. This list can then
be used to complete the various pages of the Log.
6.Patient Days Summary
II.STANDARD UNITS OF MEASURE AND ALLOCATION BASIS STATISTICS
7. Square Feet-Net, Changes Log
8. Summary of Pounds of Laundry Distributed
9. Pounds of Laundry Processed
10. Summary of Two Week Time - Study - Housekeeping
10a. Two Week Time Study - Housekeeping
11. Summary of Meals Served
12. Cafeteria Meals (Avg. # of employees)
13. Summary of Activities - Number of Participants
14. Two Week Time Study: Medical Director (time spent)
15. Two Week Time Study: Medical Records (hours of service)
16. Two Week Time Study: Social Services (hours of service)
17. Number of Trips - Transportation
18. Number of Users by Program - Transportation
19. Summary of Other Ancillary Statistics
20a-b. Classification of Physical Therapy Treatments
21a-b.Classification of Occupational Therapy Treatments
22a-b.Classification of Speech Therapy Treatments
23. Number of Pharmacy Prescriptions Filled
24. Pharmacy - Costed Requisitions
25. Central Medical Supplies-Costed Requisitions
CONTENTS/GENERAL INSTRUCTIONS (Cont'd.)
III.MEDICARE STATISTICS AND INFORMATION
26. Summary of Medical Supplies Charged to Medicare
27. Summary of Drugs Charged to Medicare
28. Summary of Medicare Billings
29a-b. Owner's Compensation Evaluation Form
IV.GENERAL INFORMATION
30a-b.Full Time Equivalents
V.ADULT DAY CARE STATISTICS
31.Hours of Service Delivered to Registrants by Payor Source
31.Number of Adult Day Care Registrants
31.Date Approved for Operation of Adult Day Care Service
32.Clinic Service Encounters
33.Adult Day Care Number of Visits by Age
VI.HEALTH PERSONNEL RECRUITMENT & RETENTION OPERATING INFORMATION
- Nursing Home Expense Funded With HR&R Funds
VII.CRIMINAL BACKGROUND CHECKS
35. Number Ordered and Cost
VIII.ALLOCATION OF PURCHASED OR CONTRACTED SERVICES
- Number Of Hours and FTEs on a Functional Basis and by Natural Classification
IX.STAFF TURNOVER
37. Number Of Employees Providing Certain Services, Salaried and Contracted