Identification, Utilization, Statistical Data

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Worksheet SectionDescriptionReference
Wkst. S, Parts IIAnalysis of Renal Dialysis Department Costs3650
Wkst. S-2Direct and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. S-3, Parts II-IIIAnalysis of Renal Dialysis Department Costs3650
Wkst. S-4Direct and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. S-5Reasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by3650
Wkst. S-6Direct and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Reclassification And Adjustment Of Trial Balance Of Expenses

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Worksheet SectionDescriptionReference
Wkst. S, Parts IIAnalysis of Renal Dialysis Department Costs3650
Wkst. S-2Direct and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. S-3, Parts II-IIIAnalysis of Renal Dialysis Department Costs3650
Wkst. S-4Direct and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. S-5Reasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by3650
Wkst. S-6Direct and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Cost and Cost Allocation

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Computation of Ratio of Costs to Charges

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Apportionment of Inpatient Cost (Routine, Ancillary, Capital), Computation of Operating Cost

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Calculation of Reimbursement Settlement

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Financial Statements

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Provider Based Home Health Agency

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Provider Based Renal Dialysis

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Provider Based CORF

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Provider Based Hospice

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Computation of Medicare Capital Payment

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650

Computation of Medicare RHC/FQHC Medicare Payment

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Worksheet SectionDescriptionReference
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IAnalysis of Renal Dialysis Department Costs3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650
Wkst. IReasonable Cost Determination for Therapy Service Furnished after April 10, 1998 by Outside3650
Wkst. IDirect and Indirect Renal Dialysis Cost Allocation - Statistical Basis3650