WHEELER CARE CENTER
WHEELER, TX  79096

Medicare Provider Number: 675534
Cost report status: As Submitted
[Record Code 66047 - 1996]

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PPS STATISTICAL DATA
PROVIDER NO:
675534
PERIOD: FROM 07/15/2000
TO 12/31/2000
WORKSHEET S-7 Part III
TRANSITION PERIOD: [ ] YEAR # 1 [ ] YEAR # 2 [ ] YEAR # 3 [ ] YEAR # 4 - 100% Federal Case Mix Rate
  HIPPS CODE GROUP FACILITY SPECIFIC RATE SERVICES PRIOR TO 10/01 SERVICES AFTER 9/30 SUBTOTAL
YR 1: Col. 9 = Col. 7 X 25%
Col. 10 = Col. 8 X 75%
 
FEDERAL
CASE MIX
RATE
DAYS
FEDERAL
CASE MIX
RATE
DAYS
FEDERAL
CASE MIX
(Col. 3 X 4,
PLUS
Col . 5 X 6)
FACILITY
SPECIFIC
(Col. 4 + 6 X
Col. 2)
 
YR 2: Col. 9 = Col. 7 X 50%
Col. 10 = Col. 8 X 50%
 
 
YR 3: Col. 9 = Col. 7 X 75%
Col. 10 = Col. 8 X 25%
 
  1 2 3 4 5 6 7 8 9 10  
1 RUC ### ### ### ### ### ### 1
2 RUB 2
3 RUA ### ### ### ### 3
4 RVC ### ### ### ### 4
5 RVB ### ### ### ### ### ### 5
6 RVA ### ### ### ### ### ### 6
7 RHC ### ### ### ### ### 7
8 RHB ### ### ### ### 8
9 RHA ### ### ### ### ### ### 9
10 RMC ### ### ### ### ### ### 10
11 RMB ### ### ### ### ### 11
12 RMA ### ### ### ### ### ### 12
13 RLB 13
14 RLA 14
15 SE3 ### ### 15
16 SE2 ### ### 16
17 SE1 ### ### 17
18 SSC ### ### ### ### ### 18
19 SSB ### ### 19
20 SSA ### ### ### ### ### ### 20
21 CC2 ### ### 21
22 CC1 ### ### 22
23 CB2 ### ### 23
24 CB1 ### ### ### ### ### 24
25 CA2 ### ### ### ### ### ### 25
26 CA1 ### ### ### ### ### 26
27 IB2 27
28 IB1 28
29 IA2 29
30 IA1 30
31 BB2 31
32 BB1 32
33 BA2 33
34 BA1 34
35 PE2 35
36 PE1 36
37 PD2 37
38 PD1 38
39 PC2 39
40 PC1 40
41 PB2 41
42 PB1 42
43 PA2 43
44 PA1 ### ### ### ### ### ### 44
45 Default Rate 45
46 TOTAL     ###   ### ### ### 46