qwwz/z: noemptyok13 Mar 2007 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num. - hosp.WQDT18 prov. num. - sub. prov.QDT18 prov. num. - sub. prov. iiDT18 prov. num. - swing bed snfDT18 prov. num. - swing bed nfDT18 prov. num. - hosp.-based snf18 prov. num. - hosp.-based nf18 prov. num. - hosp.-based hha18 prov. num. - certified asca18 prov. num. - hosp.-based hospice prov. num. - hosp.-based health clinic prov. num. - outpt. corfhealth clinic prov. num. - outpt. cmhchealth clinic prov. num. - outpt. physical therapy f prov. num. - outpt. occupational thera prov. num. - outpt. speech pathology f sat. num. - renal dialysispathology f hosp. name renal dialysispathology f manual cost report indicator (m=manual hosp. title xviii payment systemanual sub. prov. i title xviii payment syste sub. prov. ii title xviii payment syst cost reporting period begin date (ccy cost reporting period end date (ccy number of months in reporting periody type of control (see table i)periody type of hosp. (see table ii)periody type of sub. prov. i (see table ii)y type of sub. prov. ii (see table ii)y is hosp. (1) urban (2) rural?le ii)y are you eligible for disproportionate is hosp. classified as referral center does hosp. operate transplant center? kidney transplant center (ccyymmdd) heart transplant center (ccyymmdd liver transplant center (ccyymmd lung transplant center (ccyymmdd) if this is an organ procurement organi is this a teaching hosp.? (y/n)organi 'if a sole community hosp. (sch), 'ni beginning (ccyymmdd). (sch), 'ni ending (ccyymmdd) (sch), 'ni does hosp. have an agreement for swing 'if yes, enter agreement date (ccy does facility have hosp.-based snf whi 'is this a rural hosp. with a certifie ' if yes, enter snf prov. num. 'fie does hosp. qualify as a rural primary 'if yes, is this the initial 12 month 'if a rpch, is the all-inclusive metho is hosp. a rural hosp. qualifying for is hosp. an all-inclusive provider? (y 'if yes, enter method, a, b, or e' (y is this a new hosp. under 42 cfr 412.3 is this a new hosp. under 42 cfr 413.4 has a new sub. prov. been established? do you elect fully pps methodology for are you eligible for disproportionate do you elect hold harmless paymentte 'if hold harmless provider, are you on do you have title xix inpatient servic are title xix nf patients occupying ti are there any related organization or are provider based physician costs inc are physical therapy services provided are respiratory therapy services provi 'if costs for renal services are on wo if participating in the nhcmq demonstr does this hospital claim expenditures file creation date (ccyymmdd) (see no system identification (see note 10)no ssa state code (see table iii) 10)no msa/necma code(see table iii) 10)no fiscal intermediary numberii) 10)no cost report status (see table iv))no 'medicare utilization indicator (l, n, census division (see table v)r (l, n, hcfa region (see table vi)v)r (l, n, hosp. adults & pediatrics beds (see no icu bedslts & pediatrics beds (see no coronary care unit bedss beds (see no burn icu bedsunit bedss beds (see no surgical icu beds bedss beds (see no other special care bedss beds (see no nursery beds care bedss beds (see no total hosp. bedse bedss beds (see no sub. prov. i beds bedss beds (see no sub. prov. ii bedsbedss beds (see no skilled nursing facility beds (see no nursing facility bedsty beds (see no other long term care bedseds (see no hospice bedsrm care bedseds (see no total beds available in facilityee no hosp. adults & pediatrics bed days ava intensive care bed days available ava coronary care bed days available ava burn intensive care bed days available surgical intensive care bed days avail other special care bed days available nursery bed days available available total hosp. bed days availableilable sub. prov. i bed days availablelable sub. prov. ii bed days availableable skilled nursing facility bed days avai nursing facility bed days availableai other long term care bed days availabl hospice bed days availableys availabl medicare hosp. adults & pediatrics day medicare swing bed snf daysatrics day total medicare routine daysatrics day medicare icu daystine daysatrics day medicare coronary care unit dayss day medicare burn icu daysunit dayss day medicare surgical icu days dayss day medicare other special care unit days medicare inpatient days- total hosp. medicare rpch visitsys- total hosp. medicare sub. prov. i daystal hosp. medicare sub. prov. ii daysal hosp. medicare skilled nursing facility days medicare home health agency visitsays medicare hospice daysgency visitsays medicare rhc/fqhc outpt. visitstsays medicaid hosp. adults & pediatrics day medicaid hmo dayslts & pediatrics day medicaid swing bed snf daysatrics day medicaid swing bed nf daysatrics day total medicaid routine daysatrics day medicaid icu daystine daysatrics day medicaid coronary care unit dayss day medicaid burn icu daysunit dayss day medicaid surgical icu days dayss day medicaid other special care dayss day medicaid nursery days care dayss day medicaid inpatient days- total hosp.y medicaid rpch visitsys- total hosp.y medicaid sub. prov. i daystal hosp.y medicaid sub. prov. ii daysal hosp.y medicaid skilled nursing facility days medicaid nursing facility daysty days medicaid home health agency visitsays medicaid hospice daysgency visitsays medicaid rhc/fqhc outpt. visitstsays total adults & pediatrics daystsays total swing bed snf days daystsays total swing bed nf days daystsays total routine daysdays daystsays total icu daysaysdays daystsays total coronary care unit daystsays total burn icu daysunit daystsays total surgical icu days daystsays total other special care unit daysays total nursery days care unit daysays total inpatient days - hosp. daysays total rpch visitsys - hosp. daysays total sub. prov. i daysosp. daysays total sub. prov. ii dayssp. daysays total skilled nursing facility daysys total nursing facility daysty daysys total other long term daysty daysys total home health agency visitsaysys total hospice daysgency visitsaysys total rhc/fqhc outpt. visitstsaysys total observation bed daysstsaysys interns & residents - total hosp.sys interns & residents - total facilitys net interns & residents replacing non- net interns & residents replacing non- full time employees - total hosp.non- full time employees - total facility- nonpaid workers - total hosp.cility- nonpaid workers - total facilityity- medicare discharges - total hosp.ty- medicare sub. prov. i dischargesty- medicare sub. prov. ii dischargesty- medicaid discharges - total hosp.ty- medicaid sub. prov. i - dischargesy- medicaid sub. prov. ii - discharges- total discharges - all patients - hosp total discharges - all patients - sub. total discharges - all patients - sub. total salariess - all patients - sub. non-physician anesthetist part a sub. non-physician anesthetist part b sub. physician - part ahetist part b sub. physician - part bhetist part b sub. interns & residents (approved program) home office personnelpproved program) skilled nursing facilityoved program) excluded areas facilityoved program) contract labor facilityoved program) contract labor: physician - part am) home office salaries & wage-related co home office: physician part aated co wage- related costs (core)t aated co wage- related costs (other) aated co excluded areasosts (other) aated co non-physician anesthetist - part a co non-physician anesthetist - part b co physician part asthetist - part b co physician part bsthetist - part b co interns & residents (approved program) employee benefitss (approved program) administrative & generaloved program) maintenance & repairsaloved program) operation of plantrsaloved program) laundry & linen serviceoved program) housekeepingen serviceoved program) dietarypingen serviceoved program) cafeteriangen serviceoved program) maintenance of personneloved program) nursing administrationloved program) central services & supplyved program) pharmacyervices & supplyved program) medical records & medical records libr social service & medical records libr other general servicecal records libr total salarieservicecal records libr non-physician anesthetist part a libr non-physician anesthetist part b libr physician - 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other wages & related costs subtotal wage related costsated costs total (sum of lines 9-11)sated costs total overhead costs-11)sated costs net salariesd costs-11)sated costs excluded area salaries1)sated costs subtotal salariesries1)sated costs subtotal other wages & related costss subtotal wage-related costsed costss total (sum of lines 3-5)tsed costss net salaries lines 3-5)tsed costss excluded area salaries)tsed costss subtotal salaries (line 7 minus line subtotal - other wages & related costs subtotal wage related costsated costs total (sum of lines 9-11)sated costs total overhead costs-11)sated costs net salariesd costs-11)sated costs excluded area salaries1)sated costs subtotal salariesries1)sated costs subtotal other wages & related costss subtotal wage-related costsed costss total (sum of lines 3-5)tsed costss net salaries lines 3-5)tsed costss excluded area salaries)tsed costss subtotal salaries (line 7 minus line 8 subtotal - other wages & related costs subtotal wage related costsated costs total (sum of lines 9-11)sated costs total overhead costs-11)sated costs net salariesd costs-11)sated costs excluded area salaries1)sated costs subtotal salariesries1)sated costs subtotal other wages & related costss subtotal wage-related costsed costss total (sum of lines 3-5)tsed costss net salaries lines 3-5)tsed costss excluded area salaries)tsed costss subtotal salaries (line 7 minus line 8 subtotal - other wages & related costs subtotal wage related costsated costs total (sum of lines 9-11)sated costs total overhead costs-11)sated costs employee benefitsts-11)sated costs administrative & generalsated costs maintenance & repairsalsated costs operation of plantrsalsated costs laundry & linen servicesated costs housekeepingen servicesated costs dietarypingen servicesated costs cafeteriangen servicesated costs maintenance of personnelsated costs nursing administrationlsated costs central services & supplysated costs pharmacyervices & supplysated costs medical records & medical records libr social service & medical records libr other general servicecal records libr nonphysician anesthetistsrecords libr nursing schoolesthetistsrecords libr interns & residents in approved progra interns & residents in approved prog - paramedical education programd prog - adults & pediatrics - (general routine icuts & pediatrics - (general routine coronary care unit - (general routine burn icucare unit - (general routine surgical icu unit - (general routine other special care - (general routine sub. prov. i care - (general routine sub. prov. iicare - (general routine nurseryv. iicare - (general routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room & labor roomral routine anesthesiology labor roomral routine radiology - diagnosticoomral routine radiology - therapeuticomral routine radioisotopeherapeuticomral routine laboratoryeherapeuticomral routine whole blood & packed red blood cellse 'blood storing, processing, & trans.' intravenous therapyessing, & trans.' respiratory therapyessing, & trans.' physical therapypyessing, & trans.' occupational therapyssing, & trans.' speech pathologyapyssing, & trans.' electrocardiologypyssing, & trans.' electrocephalographyssing, & trans.' medical supplies charged to patients drugs charged to patientso patients renal dialysiso patientso patients asc (non-distinct part)so patients other ancillaryt part)so patients clinicncillaryt part)so patients emergencyllaryt part)so patients other outpt. services)so patients home program dialysis)so patients ambulance servicesis)so patients durable medical equipment - renteds durable medical equipment - soldds other reimbursableipment - soldds outpt. rehabilitation provider - corf outpt. rehabilitation provider -cmhc outpt. rehabilitation provider - opt outpt. rehabilitation provider - oot outpt. rehabilitation provider - osp interns & residents (non approved prog home health agency (non approved prog lung acquisitiony (non approved prog kidney acquisition (non approved prog liver acquisition (non approved prog heart acquisition (non approved prog other organ acquisition approved prog utilization review - snfapproved prog asc (distinct part) snfapproved prog hospicetinct part) snfapproved prog other special purposenfapproved prog non-reimbursable cost centersved prog total salaries - facilityersved prog old capital-related costs - buildings old capital-related costs - movable eq new capital-related costs - buildings new capital-related costs - movable eq employee benefitsd costs - movable eq administrative & general - movable eq maintenance & repairsal - movable eq operation of plantrsal - movable eq laundry & linen service - movable eq housekeepingen service - movable eq dietarypingen service - movable eq cafeteriangen service - movable eq maintenance of personnel - movable eq nursing administrationl - movable eq central services & supply- movable eq pharmacyervices & supply- movable eq medical records & medical records libr social service & medical records libr other general servicecal records libr nonphysician anesthetistsrecords libr nursing schoolesthetistsrecords libr interns & residents - salaries & fring interns & residents - other program co paramedical education programogram co adults & pediatrics - (general routine icuts & pediatrics - (general routine coronary care unit - (general routine burn icucare unit - (general routine surgical icu unit - (general routine other special care - (general routine sub. prov. i care - (general routine sub. prov. iicare - (general routine nurseryv. iicare - (general routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room & labor roomral routine anesthesiology labor roomral routine radiology - diagnosticoomral routine radiology - therapeuticomral routine radioisotopeherapeuticomral routine laboratoryeherapeuticomral routine pbp clinical laboratory service (progr whole blood & packed red blood cellsr 'blood storing, processing, & trans.' intravenous therapyessing, & trans.' respiratory therapyessing, & trans.' physical therapypyessing, & trans.' occupational therapyssing, & trans.' speech pathologyapyssing, & trans.' electrocardiologypyssing, & trans.' electrocephalographyssing, & trans.' medical supplies charged to patients drugs charged to patientso patients renal dialysiso patientso patients asc (non-distinct part)so patients other ancillaryt part)so patients clinicncillaryt part)so patients emergencyllaryt part)so patients other outpt. services)so patients home program dialysis)so patients ambulance servicesis)so patients durable medical equipment - renteds durable medical equipment - soldds other reimbursableipment - soldds outpt. rehabilitation provider - corf outpt. rehabilitation provider -cmhc outpt. rehabilitation provider - opt outpt. rehabilitation provider - oot outpt. rehabilitation provider - osp interns & residents (non approved prog home health agency (non approved prog lung acquisitiony (non approved prog kidney acquisition (non approved prog liver acquisition (non approved prog heart acquisition (non approved prog other organ acquisition approved prog interest expensesition approved prog utilization review - snfapproved prog other capital-related costsroved prog asc (distinct part)d costsroved prog hospicetinct part)d costsroved prog other special purposecostsroved prog nonreimbursable cost centersoved prog total other costs - facilityoved prog old capital-related costs - buildings old capital-related costs - movable eq new capital-related costs- buildings new capital-related costs - movable eq employee benefitsd costs - movable eq administrative & general - movable eq maintenance & repairsal - movable eq operation of plantrsal - movable eq laundry & linen service - movable eq housekeepingen service - movable eq dietarypingen service - movable eq cafeteriangen service - movable eq maintenance of personnel - movable eq nursing administrationl - movable eq central services & supply- movable eq pharmacyervices & supply- movable eq medical records & medical records libr social service & medical records libr other general servicecal records libr nonphysician anesthetistsrecords libr nursing schoolesthetistsrecords libr interns & residents - salaries & fring interns & residents - other program co paramedical education programogram co adults & pediatrics - (general routine icuts & pediatrics - (general routine coronary care unit - (general routine burn icucare unit - (general routine surgical icu unit - (general routine other special care - (general routine sub. prov. i care - (general routine sub. prov. iicare - (general routine nurseryv. iicare - (general routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room and labor rooml routine anesthesiologynd labor rooml routine radiology - diagnostic rooml routine radiology - therapeuticrooml routine radioisotopeherapeuticrooml routine laboratoryeherapeuticrooml routine pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, & trans.' intravenous therapyessing, & trans.' respiratory therapyessing, & trans.' physical therapypyessing, & trans.' occupational therapyssing, & trans.' speech pathologyapyssing, & trans.' electrocardiologypyssing, & trans.' electroencephalographying, & trans.' medical supplies charged to patients drugs charged to patientso patients renal dialysiso patientso patients asc (non-distinct part)so patients other ancillaryt part)so patients clinicncillaryt part)so patients emergencyllaryt part)so patients other outpt. services)so patients home program dialysis)so patients ambulance servicesis)so patients durable medical equipment - renteds durable medical equipment - soldds other reimbursableipment - soldds outpt. rehabilitation provider - corf outpt. rehabilitation provider - cmhc outpt. rehabilitation provider - opt outpt. rehabilitation provider - oot outpt. rehabilitation provider - osp intern & resident service (non-approve home health agencyervice (non-approve lung acquisitionyervice (non-approve kidney acquisitionervice (non-approve liver acquisitionervice (non-approve heart acquisitionervice (non-approve other organ acquisitione (non-approve asc (distinct part)ione (non-approve hospicetinct part)ione (non-approve other special purposene (non-approve nonreimbursable cost centersn-approve total cost before allocation - facilit nonphysician anesthetistson - facilit nursing schoolesthetistson - facilit interns & residents - salary & fringes interns & residents - program costs (a paramedical educationprogram costs (a adults & pediatrics - (general routine icuts & pediatrics - (general routine coronary care unit - (general routine burn icucare unit - (general routine surgical icu unit - (general routine other special care - (general routine sub. prov. i care - (general routine sub. prov. iicare - (general routine nurseryv. iicare - (general routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room and labor rooml routine anesthesiologynd labor rooml routine radiology - diagnostic rooml routine radiology - therapeuticrooml routine radioisotopeherapeuticrooml routine laboratoryeherapeuticrooml routine pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, & trans.' intravenous therapyessing, & trans.' respiratory therapyessing, & trans.' physical therapypyessing, & trans.' occupational therapyssing, & trans.' speech pathologyapyssing, & trans.' electrocardiologypyssing, & trans.' electroencephalographying, & trans.' medical supplies charged to patients drugs charged to patientso patients renal dialysiso patientso patients asc (non-distinct part)so patients other ancillaryt part)so patients clinicncillaryt part)so patients emergencyllaryt part)so patients other outpt. services)so patients home program dialysis)so patients ambulance servicesis)so patients durable medical equipment - renteds durable medical equipment - soldds other reimbursableipment - soldds outpt. rehabilitation provider - corf outpt. rehabilitation provider - cmhc outpt. rehabilitation provider - opt outpt. rehabilitation provider - oot outpt. rehabilitation provider - osp interns & residents service (non-appro home health agency service (non-appro lung acquisitiony service (non-appro kidney acquisition service (non-appro liver acquisition service (non-appro heart acquisition service (non-appro other organ acquisitionice (non-appro asc (distinct part)ionice (non-appro hospicetinct part)ionice (non-appro other special purposenice (non-appro nonreimbursable cost centersnon-appro cross foot adjustmentsntersnon-appro negative cost centersntersnon-appro total costs - facilityntersnon-appro respiratory therapy limit adjustmento physical therapy limit adjustmentnto adults & pediatrics - (general routine icuts & pediatrics - (general routine cororonary care unit (general routine burn icuy care unit (general routine surgical icure unit (general routine other special caret (general routine sub. prov. i caret (general routine sub. prov. iicaret (general routine nurseryv. iicaret (general routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room & labor roomral routine anesthesiology labor roomral routine radiology - diagnosticoomral routine radiology - therapeuticomral routine radioisotopeherapeuticomral routine laboratoryeherapeuticomral routine pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulance servicesis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl subtotalmbursable costs - solddsl less: observation beds - solddsl total costs - facility (line 101 minus total capital reduction - facilitynus total operating cost reduction - facil adults & pediatrics - (general routine icuts & pediatrics - (general routine cororonary care unit (general routine burn icuy care unit (general routine surgical icure unit (general routine other special caret (general routine sub. prov. i caret (general routine sub. prov. iicaret (general routine nurseryv. iicaret (general routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room & labor roomral routine anesthesiology labor roomral routine radiology - diagnosticoomral routine radiology - therapeuticomral routine radioisotopeherapeuticomral routine laboratoryeherapeuticomral routine pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulance servicesis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl operating roomble costs - solddsl recovery roomble costs - solddsl delivery room & labor room solddsl anesthesiology labor room solddsl radiology - diagnosticoom solddsl radiology - therapeuticom solddsl radioisotopeherapeuticom solddsl laboratoryeherapeuticom solddsl pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulance servicesis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl operating roomble costs - solddsl recovery roomble costs - solddsl delivery room & labor room solddsl anesthesiology labor room solddsl radiology - diagnosticoom solddsl radiology - therapeuticom solddsl radioisotopeherapeuticom solddsl laboratoryeherapeuticom solddsl pbp clinical lab services solddsl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. servicet)so patientsl home program dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl operating roomble costs - solddsl recovery roomble costs - solddsl delivery room & labor room solddsl anesthesiology labor room solddsl radiology - diagnosticoom solddsl radiology - therapeuticom solddsl radioisotopeherapeuticom solddsl laboratoryeherapeuticom solddsl pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl adults & pediatrics - (general routine icuts & pediatrics - (general routine coronary care unit - (general routine burn icucare unit - (general routine surgical icu unit - (general routine other special care uniteneral routine operating roomare uniteneral routine recovery roomare uniteneral routine delivery room & labor roomral routine anesthesiology labor roomral routine radiology - diagnosticoomral routine radiology - therapeuticomral routine radioisotopeherapeuticomral routine laboratoryeherapeuticomral routine pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. servicet)so patientsl home program dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total medicare part a ancillary charge net medicare part a ancillary charges operating roomrt a ancillary charges recovery roomrt a ancillary charges delivery room & labor roomry charges anesthesiology labor roomry charges radiology - diagnosticoomry charges radiology - therapeuticomry charges radioisotopeherapeuticomry charges laboratoryeherapeuticomry charges pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. servicet)so patientsl home program dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total medicare part a costs - hosp.l total swing-bed cost costs - hosp.l general inpatient routine service.l general inpatient routine service cost general inpatient routine servicecost icu - medicare costutine servicecost coronary care unit - medicare costost burn icu - medicare costcare costost surgical icu - medicare cost costost other special care unit - medicare cos medicare inpatient ancillaryicare cos 'total medicare inpatient operating co pass through costs - program inpatient pass through costs - program inpatient total program excludable costspatient total program inpatient operating cost tefra target amount per dischargeost target amountmount per dischargeost difference between adjusted inpatient incentive/penalty paymentd inpatient inpatient cost plus incentive payment operating roomplus incentive payment recovery roomplus incentive payment delivery room & labor roomve payment anesthesiology labor roomve payment radiology - diagnosticoomve payment radiology - therapeuticomve payment radioisotopeherapeuticomve payment laboratoryeherapeuticomve payment pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total medicare part a ancillary costs general inpatient routine service cost general inpatient routine service cost total program general inpatient routin medicare inpatient ancillary costutin total medicare inpatient operating cos pass through costs - program inpatient pass through costs - program inpatient total program excludable costspatient total program inpatient operating cost tefra target amount per dischargecost target amountmount per dischargecost difference between adjusted inpatient incentive/penalty amounted inpatient inpatient cost plus incentive payment operating roomplus incentive payment recovery roomplus incentive payment delivery room & labor roomve payment anesthesiology labor roomve payment radiology - diagnosticoomve payment radiology - therapeuticomve payment radioisotopeherapeuticomve payment laboratoryeherapeuticomve payment pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total medicare part a ancillary costs general inpatient routine service cost general inpatient routine service cost total program general inpatient routin medicare inpatient ancillary costutin total medicare inpatient operating cos pass through costs - program inpatient pass through costs - program inpatient total program excludable costspatient total program inpatient operating cost tefra target amount per dischargecost target amountmount per dischargecost difference between adjusted inpatient incentive/penalty amounted inpatient inpatient cost plus incentive payment operating roomplus incentive payment recovery roomplus incentive payment delivery room & labor roomve payment anesthesiology labor roomve payment radiology - diagnosticoomve payment radiology - therapeuticomve payment radioisotopeherapeuticomve payment laboratoryeherapeuticomve payment pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna chargessable costs - solddsl total asc medicare part b charges - ho operating roomare part b charges - ho recovery roomare part b charges - ho delivery room & labor roomharges - ho anesthesiology labor roomharges - ho radiology - diagnosticoomharges - ho radiology - therapeuticomharges - ho radioisotopeherapeuticomharges - ho laboratoryeherapeuticomharges - ho pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total outpt. radiology medicare part b operating roomdiology medicare part b recovery roomdiology medicare part b delivery room & labor roomcare part b anesthesiology labor roomcare part b radiology - diagnosticoomcare part b radiology - therapeuticomcare part b radioisotopeherapeuticomcare part b laboratoryeherapeuticomcare part b pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total other outpt. diagnostic medicare operating roompt. diagnostic medicare recovery roompt. diagnostic medicare delivery room & labor roomic medicare anesthesiology labor roomic medicare radiology - diagnosticoomic medicare radiology - therapeuticomic medicare radioisotopeherapeuticomic medicare laboratoryeherapeuticomic medicare pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna chargessable costs - solddsl pbp other part b charges - solddsl total other medicare part b charges - operating roomicare part b charges - recovery roomicare part b charges - delivery room & labor room charges - anesthesiology labor room charges - radiology - diagnosticoom charges - radiology - therapeuticom charges - radioisotopeherapeuticom charges - laboratoryeherapeuticom charges - pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna chargessable costs - solddsl pbp clinical lab charges - solddsl total other medicare part b charges - operating roomicare part b charges - recovery roomicare part b charges - delivery room & labor room charges - anesthesiology labor room charges - radiology - diagnosticoom charges - radiology - therapeuticom charges - radioisotopeherapeuticom charges - laboratoryeherapeuticom charges - pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna chargessable costs - solddsl pbp clinical lab charges - solddsl total other medicare part b chargesl operating roomicare part b chargesl recovery roomicare part b chargesl delivery room & labor room chargesl anesthesiology labor room chargesl radiology - diagnosticoom chargesl radiology - therapeuticom chargesl radioisotopeherapeuticom chargesl laboratoryeherapeuticom chargesl pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna costsursable costs - solddsl total asc medicare part b costs - hosp operating roomare part b costs - hosp recovery roomare part b costs - hosp delivery room & labor roomosts - hosp anesthesiology labor roomosts - hosp radiology - diagnosticoomosts - hosp radiology - therapeuticomosts - hosp radioisotopeherapeuticomosts - hosp laboratoryeherapeuticomosts - hosp pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total ouptatient radiology medicare pa operating roomt radiology medicare pa recovery roomt radiology medicare pa delivery room & labor roommedicare pa anesthesiology labor roommedicare pa radiology - diagnosticoommedicare pa radiology - therapeuticommedicare pa radioisotopeherapeuticommedicare pa laboratoryeherapeuticommedicare pa pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl total other outpt. diagnostic medicare operating roompt. diagnostic medicare recovery roompt. diagnostic medicare delivery room & labor roomic medicare anesthesiology labor roomic medicare radiology - diagnosticoomic medicare radiology - therapeuticomic medicare radioisotopeherapeuticomic medicare laboratoryeherapeuticomic medicare pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna costsursable costs - solddsl total other medicare part b costs - ho operating roomicare part b costs - ho recovery roomicare part b costs - ho delivery room & labor room costs - ho anesthesiology labor room costs - ho radiology - diagnosticoom costs - ho radiology - therapeuticom costs - ho radioisotopeherapeuticom costs - ho laboratoryeherapeuticom costs - ho pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna costsursable costs - solddsl total other medicare part b costs - su operating roomicare part b costs - su recovery roomicare part b costs - su delivery room & labor room costs - su anesthesiology labor room costs - su radiology - diagnosticoom costs - su radiology - therapeuticom costs - su radioisotopeherapeuticom costs - su laboratoryeherapeuticom costs - su pbp clinical lab services (program onl whole blood & packed red blood cellsl 'blood storing, processing, trans.'l intravenous therapyessing, trans.'l respiratory therapyessing, trans.'l physical therapypyessing, trans.'l occupational therapyssing, trans.'l speech pathologyapyssing, trans.'l electrocardiologypyssing, trans.'l electroencephalographying, trans.'l medical supplies charged to patientsl drugs charged to patientso patientsl renal dialysiso patientso patientsl asc (non-distinct part)so patientsl other ancillaryt part)so patientsl clinicncillaryt part)so patientsl emergencyllaryt part)so patientsl observation beds part)so patientsl other outpt. services)so patientsl home program dialysis)so patientsl ambulanceam dialysis)so patientsl durable medical equipment - rentedsl durable medical equipment - solddsl other reimbursable costs - solddsl crna costsursable costs - solddsl total other medicare part b costs - su land other medicare part b costs - su land improvementsre part b costs - su buildings and fixturesrt b costs - su building improvementsrt b costs - su fixed equipmentmentsrt b costs - su movable equipmentntsrt b costs - su subtotalquipmentntsrt b costs - su total assets - facilityt b costs - su land assets - facilityt b costs - su land improvementsilityt b costs - su buildings and fixturest b costs - su building improvementst b costs - su fixed equipmentmentst b costs - su movable equipmentntst b costs - su subtotalquipmentntst b costs - su total purchases - facility costs - su land purchases - facility costs - su land improvementsfacility costs - su buildings and fixturesity costs - su building improvementsity costs - su fixed equipmentmentsity costs - su movable equipmentntsity costs - su subtotalquipmentntsity costs - su total donations - facility costs - su land donations - facility costs - su land improvementsfacility costs - su buildings and fixturesity costs - su building improvementsity costs - su fixed equipmentmentsity costs - su movable equipmentntsity costs - su subtotalquipmentntsity costs - su total disposals & retirements - facili land disposals & retirements - facili land improvementsretirements - facili buildings and fixturesements - facili building improvementsements - facili fixed equipmentmentsements - facili movable equipmentntsements - facili subtotalquipmentntsements - facili total fully depreciated assets - facil land fully depreciated assets - facil land improvementsiated assets - facil buildings and fixtures assets - facil building improvements assets - facil fixed equipmentments assets - facil movable equipmentnts assets - facil subtotalquipmentnts assets - facil total assets - facilityassets - facil land assets - facilityassets - facil land improvementsilityassets - facil buildings and fixturesassets - facil building improvementsassets - facil fixed equipmentmentsassets - facil movable equipmentntsassets - facil subtotalquipmentntsassets - facil total purchases - facilityets - facil land purchases - facilityets - facil land improvementsfacilityets - facil buildings and fixturesityets - facil building improvementsityets - facil fixed equipmentmentsityets - facil movable equipmentntsityets - facil subtotalquipmentntsityets - facil total donations - facilityets - facil land donations - facilityets - facil land improvementsfacilityets - facil buildings and fixturesityets - facil building improvementsityets - facil fixed equipmentmentsityets - facil movable equipmentntsityets - facil subtotalquipmentntsityets - facil total disposals & retirements facility land disposals & retirements facility land improvementsretirements facility building improvementsrements facility fixed equipmentmentsrements facility movable equipmentntsrements facility subtotalquipmentntsrements facility total fully depreciated assets - facil old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total insurance costs - facilitye equ old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total taxes - facilityt - movable equ old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total other capital-related costs - fa old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total depreciation - facilityable equ old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total lease costs - facilityvable equ old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total interest costs - facilityle equ old capital-related cost - building & old capital-related cost - movable equ new capital-related cost - building & new capital-related cost - movable equ total capital-related costs - facility total directly assigned old capital re adults and pediatrics (general routine icuts and pediatrics (general routine coronary care unitcs (general routine burn icucare unitcs (general routine surgical icu unitcs (general routine other special care uniteneral routine sub. prov. i care uniteneral routine sub. prov. iicare uniteneral routine nurseryv. iicare uniteneral routine skilled nursing facilityneral routine nursing facilityacilityneral routine other long term careityneral routine operating room careityneral routine recovery room careityneral routine delivery room and labor rooml routine anesthesiologynd labor rooml routine radiology - diagnostic rooml routine radiology - therapeuticrooml routine radioisotopeherapeuticrooml routine laboratoryeherapeuticrooml routine whole blood and packed red blood cells 'blood storing, processing, trans'lls intravenous therapyessing, trans'lls respiratory therapyessing, trans'lls physical therapypyessing, trans'lls occupational therapyssing, trans'lls speech pathologyapyssing, trans'lls electrocardiologypyssing, trans'lls electroencephalographying, trans'lls medical supplies charged to patientss drugs charged to patientso patientss renal dialysiso patientso patientss asc (non-distinct part)so patientss other ancillaryt part)so patientss clinicncillaryt part)so patientss emergencyllaryt part)so patientss other outpt. services)so patientss home program dialysis)so patientss ambulanceam dialysis)so patientss durable medical equipment - rentedss durable medical equipment - solddss other reimbursable costs - solddss outpt. rehabilitation providers (total intern - resident service (not in appr home health agencyervice (not in appr lung acquisitionyervice (not in appr kidney acquisitionervice (not in appr liver acquisitionervice (not in appr heart acquisitionervice (not in appr other organ acquisitione (not in appr ambulatory surgical center (distinct p hospicery surgical center (distinct p other special purposenter (distinct p nonreimbursable costsnter (distinct p cross foot adjustmentster (distinct p negative cost centerster (distinct p total old capital related costs - faci total directly assigned new capital re adults & pediatrics (general routine c icuts & pediatrics (general routine c coronary care unit (general routine c burn icucare unit (general routine c surgical icu unit (general routine c other special care uniteral routine c sub. prov. i care uniteral routine c sub. prov. iicare uniteral routine c nurseryv. iicare uniteral routine c skilled nursing facilityral routine c nursing facilityacilityral routine c other long term careityral routine c operating room careityral routine c recovery room careityral routine c delivery room & labor rooml routine c anesthesiology labor rooml routine c radiology - diagnosticooml routine c radiology - therapeuticoml routine c radioisotopeherapeuticoml routine c laboratoryeherapeuticoml routine c whole blood & packed red blood cellsc 'blood storing, processing, trans.'c intravenous therapyessing, trans.'c respiratory therapyessing, trans.'c physical therapypyessing, trans.'c occupational therapyssing, trans.'c speech pathologyapyssing, trans.'c electrocardiologypyssing, trans.'c electroencephalographying, trans.'c medical supplies charged to patientsc drugs charged to patientso patientsc renal dialysiso patientso patientsc asc (non-distinct part)so patientsc other ancillaryt part)so patientsc clinicncillaryt part)so patientsc emergencyllaryt part)so patientsc other outpt. services)so patientsc home program dialysis)so patientsc ambulanceam dialysis)so patientsc durable medical equipment - rentedsc durable medical equipment - solddsc other reimbursable costs - solddsc outpt. rehab providers (total)ddsc intern - resident service (not in appr home health agencyervice (not in appr lung acquisitionyervice (not in appr kidney acquisitionervice (not in appr liver acquisitionervice (not in appr heart acquisitionervice (not in appr other organ acquisitione (not in appr ambulatory surgical centernot in appr hospicery surgical centernot in appr other special purposenternot in appr nonreimbursable costsnternot in appr cross foot adjustmentsternot in appr negative cost centersternot in appr total new capital related costs - faci adults & pediatrics (general routine c icuts & pediatrics (general routine c coronary care unit (general routine c burn icucare unit (general routine c surgical icu unit (general routine c other special care uniteral routine c sub. prov. i care uniteral routine c sub. prov. iicare uniteral routine c nurseryv. iicare uniteral routine c total medicare part a inpatient routin adults & pediatrics (general routine c icuts & pediatrics (general routine c coronary care unit (general routine c burn icucare unit (general routine c surgical icu unit (general routine c other special care uniteral routine c sub. prov. i care uniteral routine c sub. prov. iicare uniteral routine c nurseryv. iicare uniteral routine c total medicare a inpatient routine new operating rooma inpatient routine new recovery rooma inpatient routine new delivery room & labor roomroutine new anesthesiology labor roomroutine new radiology - diagnosticoomroutine new radiology - therapeuticomroutine new radioisotopeherapeuticomroutine new laboratoryeherapeuticomroutine new whole blood & packed red blood cellsw 'blood storing, processing, trans.'w intravenous therapyessing, trans.'w respiratory therapyessing, trans.'w physical therapypyessing, trans.'w occupational therapyssing, trans.'w speech pathologyapyssing, trans.'w electrocardiologypyssing, trans.'w electroencephalographying, trans.'w medial supplies charged to patientsw drugs charged to patients patientsw renal dialysiso patients patientsw asc (non-distinct part)s patientsw other ancillaryt part)s patientsw clinicncillaryt part)s patientsw emergencyllaryt part)s patientsw observation beds part)s patientsw other outpt. services)s patientsw home program dialysis)s patientsw durable medical equipment - rentedw durable medical equipment - solddw other reimbursable costs - solddw total medicare part a ancillary old ca operating roompart a ancillary old ca recovery roompart a ancillary old ca delivery room & labor roomlary old ca anesthesiology labor roomlary old ca radiology - diagnosticoomlary old ca radiology - therapeuticomlary old ca radioisotopeherapeuticomlary old ca laboratoryeherapeuticomlary old ca whole blood & packed red blood cellsa 'blood storing, processing, trans.'a intravenous therapyessing, trans.'a respiratory therapyessing, trans.'a physical therapypyessing, trans.'a occupational therapyssing, trans.'a speech pathologyapyssing, trans.'a electrocardiologypyssing, trans.'a electroencephalographying, trans.'a medial supplies charged to patientsa drugs charged to patients patientsa renal dialysiso patients patientsa asc (non-distinct part)s patientsa other ancillaryt part)s patientsa clinicncillaryt part)s patientsa emergencyllaryt part)s patientsa observation beds part)s patientsa other outpt. services)s patientsa home program dialysis)s patientsa durable medical equipment - renteda durable medical equipment - soldda other reimbursable costs - soldda total medicare part a ancillary new ca total medicare part a ancillary old c total medicare part a ancillary new c total medicare part a ancillary old c total medicare part a ancillary new c adults & pediatrics (general routine c icuts & pediatrics (general routine c coronary care unit (general routine c burn icucare unit (general routine c surgical icu unit (general routine c other special care uniteral routine c sub. prov. i care uniteral routine c sub. prov. iicare uniteral routine c nurseryv. iicare uniteral routine c total medicare part a inpatient routin operating roompart a inpatient routin recovery roompart a inpatient routin delivery room & labor roomient routin anesthesiology labor roomient routin radiology - diagnosticoomient routin radiology - therapeuticomient routin radioisotopeherapeuticomient routin laboratoryeherapeuticomient routin whole blood & packed red blood cellsn 'blood storing, processing, trans.'n intravenous therapyessing, trans.'n respiratory therapyessing, trans.'n physical therapypyessing, trans.'n occupational therapyssing, trans.'n speech pathologyapyssing, trans.'n electrocardiologypyssing, trans.'n 01000101S001 017016 014506 SOUTHEAST ALABAMA MEDICAL CENTER PT199510011996093012 91401YNN 0 0 0 0 N0 0 0N 0NN NNNNNNNNYYNNYNNYNNN0N199810282 000 1218000010JF504P $`(#,&3xlgg^ `,;?|$**rcZ(z#EmYs0%v  p?|$**lcZ(z#fYs0%v  pAG O,c`LDP9Vap^! 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