Worksheet S-7
- Return to Cost Report Summary
- Form S700
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV
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CONCORD, NH 03301
CONCORD, NH 03301
Medicare Provider Number: 305045
Cost report status: Settled Without Audit
[Record Code 1281282 - 2010]
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PROSPECTIVE PAYMENT FOR SNF STATISTICAL DATA | Provider CCN: 305045 | PERIOD: FROM 10/01/2019 TO 09/30/2020 |
WORKSHEET S-7 | ||
RUGS GROUPS (Through September 30, 2019) | Days | ||||
1 | 2 | ||||
1 | RUX | 1 | |||
2 | RUL | 2 | |||
3 | RVX | 3 | |||
4 | RVL | 4 | |||
5 | RHX | 5 | |||
6 | RHL | 6 | |||
7 | RMX | 7 | |||
8 | RML | 8 | |||
9 | RLX | 9 | |||
10 | RUC | 10 | |||
11 | RUB | 11 | |||
12 | RUA | 12 | |||
13 | RVC | 13 | |||
14 | RVB | 14 | |||
15 | RVA | 15 | |||
16 | RHC | 16 | |||
17 | RHB | 17 | |||
18 | RHA | 18 | |||
19 | RMC | 19 | |||
20 | RMB | 20 | |||
21 | RMA | 21 | |||
22 | RLB | 22 | |||
23 | RLA | 23 | |||
24 | ES3 | 24 | |||
25 | ES2 | 25 | |||
26 | ES1 | 26 | |||
27 | HE2 | 27 | |||
28 | HE1 | 28 | |||
29 | HD2 | 29 | |||
30 | HD1 | 30 | |||
31 | HC2 | 31 | |||
32 | HC1 | 32 | |||
33 | HB2 | 33 | |||
34 | HB1 | 34 | |||
35 | LE2 | 35 | |||
36 | LE1 | 36 | |||
37 | LD2 | 37 | |||
38 | LD1 | 38 | |||
39 | LC2 | 39 | |||
40 | LC1 | 40 | |||
41 | LB2 | 41 | |||
42 | LB1 | 42 | |||
43 | CE2 | 43 | |||
44 | CE1 | 44 | |||
45 | CD2 | 45 | |||
46 | CD1 | 46 | |||
47 | CC2 | 47 | |||
48 | CC1 | 48 | |||
49 | CB2 | 49 | |||
50 | CB1 | 50 | |||
51 | CA2 | 51 | |||
52 | CA1 | 52 | |||
53 | SE3 | 53 | |||
54 | SE2 | 54 | |||
55 | SE1 | 55 | |||
56 | SSC | 56 | |||
57 | SSB | 57 | |||
58 | SSA | 58 | |||
59 | IB2 | 59 | |||
60 | IB1 | 60 | |||
61 | IA2 | 61 | |||
62 | IA1 | 62 | |||
63 | BB2 | 63 | |||
64 | BB1 | 64 | |||
65 | BA2 | 65 | |||
66 | BA1 | 66 | |||
67 | PE2 | 67 | |||
68 | PE1 | 68 | |||
69 | PD2 | 69 | |||
70 | PD1 | 70 | |||
71 | PC2 | 71 | |||
72 | PC1 | 72 | |||
73 | PB2 | 73 | |||
74 | PB1 | 74 | |||
75 | PA2 | 75 | |||
76 | PA1 | 76 | |||
99 | AAA | 99 | |||
100 | Total | 100 | |||
A notice published in the "Federal Register" Vol. 68, No. 149 August 4, 2003 provided for an increase in the RUG payments beginning 10/01/2003 Congress expected this increase to be used for direct patient care and related expenses. For lines 101 through 106: Enter in column 1 the amount of expense for each category. Enter in column 2 the percentage of total expenses for each category to total SNF revenue from Worksheet G-2, Part I line 1 column 3. Indicate in column 3 "Y" for yes or "N" for no if the spending reflects increases associated with direct patient care and related expenses for each category. (If column 2 is zero, enter N/A in column 3) (see instructions) | |||||
Expenses | Percentage | Y/N | |||
1 | 2 | 3 | |||
101 | Staffing | ### | ### | ### | 101 |
102 | Recruitment | ### | ### | ### | 102 |
103 | Retention of employees | ### | ### | ### | 103 |
104 | Training | ### | ### | ### | 104 |
105 | Other (Specify) | ### | ### | ### | 105 |
106 | Total SNF revenue (Wkst. G-2, Pt. I, line 1, col. 3) |
### | 106 | ||
FORM CMS-2540-10 (11/2019) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTIONS 4109 - 4109.1) | |||||
41-314 | Rev. 9 |