SNFData - 495283 - 05/2001 - Worksheet S-7, Part IV

MCHS - IMPERIAL
RICHMOND, VA 23227-

Medicare Provider Number: 495283

Cost report status: As Submitted

[Record Code 28145 - 1996]

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PROSPECTIVE PAYMENT FOR SNF STATISTICAL DATA				PROVIDER NO: 495283		PERIOD FROM 06/01/2000 TO 05/31/2001			WORKSHEET S-7, PART IV
	GROUP (1)	M3PI REV CODE	SERVICES PRIOR TO October 1		SERVICES ON OR AFTER October 1		AIDS Diagnosis 042 Prior to 10/01		HIGH COST RUGs (2)	TOTAL (see instructions)
	GROUP (1)	M3PI REV CODE	RATE	DAYS	RATE	DAYS	RATE	DAYS	DAYS	TOTAL (see instructions)
	1	2	3	3.01	4	4.01	4.02	4.03	4.05	5
1	RUC		###		###		###				1
2	RUB		###	###	###		###			###	2
3	RUA		###		###		###				3
3.01	RUX										3.01
3.02	RUL										3.02
4	RVC		###		###		###				4
5	RVB		###	###	###		###			###	5
6	RVA		###	###	###		###			###	6
6.01	RVX										6.01
6.02	RVL										6.02
7	RHC		###	###	###		###			###	7
8	RHB		###	###	###		###			###	8
9	RHA		###	###	###		###			###	9
9.01	RHX										9.01
9.02	RHL										9.02
10	RMC		###	###	###		###			###	10
11	RMB		###	###	###		###			###	11
12	RMA		###	###	###		###			###	12
12.01	RMX										12.01
12.02	RML										12.02
13	RLB		###		###		###				13
14	RLA		###	###	###		###			###	14
14.01	RLX										14.01
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