Report Record Number
Adults and Pediatrics A000000 03000 00100
Adults and Pediatrics A000000 03000 00200
Adults and Pediatrics A000000 03000 00600
Interest Expense A000000 11300 00200
Total Salaries A000000 20000 00100
Total Salaries A000000 20000 00200
Total Salaries A000000 20000 00600
Land A700001 00100 00100
Buildings and Fixtures A700001 00300 00100
Building Improvements A700001 00400 00100
Movable Equipment A700001 00600 00100
Movable Equipment A700001 00600 00200
Subtotal A700001 00800 00100
Subtotal A700001 00800 00200
Total A700001 01000 00100
Total A700001 01000 00200
Total A700003 00300 00900
Total A700003 00300 01500
Investment Income-Other A800000 00300 00200
Provider-based physician adjustment A800000 01000 00200
Sale of medical records and abstracts A800000 01800 00200
Vending Machines A800000 02000 00200
Total A800000 05000 00200
Adults and Pediatrics B000001 03000 00000
Adults and Pediatrics B000001 03000 02600
Total B000001 20200 00000
Total B000001 20200 02600
Adults & Pediatrics B000002 03000 02600
Total B000002 20200 02600
Adults & Pediatrics C000001 03000 00500
Adults & Pediatrics C000001 03000 00600
Subtotal C000001 20000 00500
C000001 20000 00600
C000001 20000 00700
Less Observation Beds C000001 20100 00500
Total C000001 20200 00500
Total C000001 20200 00600
Total C000001 20200 00700
Adults & Pediatrics D00A181 03000 00400
Adults & Pediatrics D00A181 03000 00600
Adults & Pediatrics D00A181 03000 00700
Total D00A181 20000 00400
Total D00A181 20000 00600
Total D00A181 20000 00700
D00A182 09200 00500
D00A182 20000 00500
Total Patient Days D00A183 20000 00600
Total Inpatient Program Days D00A183 20000 00800
Total D00A185 20000 00200
Total D00A185 20000 00400
Total D00A185 20000 00500
Total D00A185 20000 00700
net of Swing Bed Cost D10A181 02700 00100
net of Swing Bed and Private Room Diff D10A181 03700 00100
Total Program General Inpatient Routine D10A181 04100 00100
Program Inpatient Ancillary Service Cost D10A181 04800 00100
Total Program Inpatient Costs D10A181 04900 00100
Pass Through Cost for Program Ancillary D D10A181 05100 00100
Total Program Excludable Costs D10A181 05200 00100
Anesthetist, and Medical Education Costs D10A181 05300 00100
Adults and Pediatrics D30A180 03000 00200
D30A180 20000 00200
TOTAL D30A180 20000 00300
D30A180 20200 00200
E00A18A 00400 00100
E00A18A 03000 00100
E00A18A 03100 00100
E00A18A 03200 00100
E00A18A 03300 00100
E00A18A 03400 00100
E00A18A 03600 00100
E00A18A 04700 00100
E00A18A 04900 00100
E00A18A 05000 00100
E00A18A 05900 00100
E00A18A 06100 00100
E00A18A 06200 00100
E00A18A 06400 0010 E00A18A 06400 00100
E00A18A 06500 0010 E00A18A 06500 00100
E00A18A 06600 0010 E00A18A 06600 00100
E00A18A 06700 0010 E00A18A 06700 00100
E00A18A 07100 0010 E00A18A 07100 00100
E00A18A 07200 0010 E00A18A 07200 00100
E00A18A 07400 0010 E00A18A 07400 00100
E00A18B 00100 00100
E00A18B 00200 00100
E00A18B 00300 00100
E00A18B 00500 00100
E00A18B 00600 00100
E00A18B 00700 00100
E00A18B 01100 00100
E00A18B 01400 00100
E00A18B 01800 00100
E00A18B 01900 00100
E00A18B 02100 00100
E00A18B 02400 00100
E00A18B 02600 00100
E00A18B 02700 00100
E00A18B 03000 00100
E00A18B 03200 00100
E00A18B 03400 00100
E00A18B 03500 00100
E00A18B 03600 00100
E00A18B 03700 00100
E00A18B 04000 00100
E00A18B 04100 00100
E00A18B 04300 00100
G200000 00100 00100
G200000 01000 00100
G200000 01700 00100
G200000 01800 00100
G200000 01800 00200
G200000 01900 00100
G200000 01900 00200
G200000 02800 00100
G200000 02800 00200
G200000 04300 00200
G300000 00100 00100
G300000 00200 00100
G300000 00300 00100
G300000 00400 00100
G300000 00500 00100
G300000 00600 00100
G300000 00700 00100
G300000 01800 00100
G300000 02100 00100
G300000 02300 00100
G300000 02500 00100
G300000 02600 00100
G300000 02900 00100
Urban/Rural Indicator at beginning S200001 02600 00100
Urban (1) or Rural (2) S200001 02700 00100
Hospital Adults & Pediatrics S300001 00100 00200
Hospital Adults & Pediatrics S300001 00100 00300
Hospital Adults & Pediatrics S300001 00100 00600
Hospital Adults & Pediatrics S300001 00100 00700
Hospital Adults & Pediatrics S300001 00100 00800
S300001 00100 01300
S300001 00100 01400 S300001 00100 01400
S300001 00100 01500 S300001 00100 01500
Total S300001 00700 00200
Total Hospital S300001 00700 00300
Total Adults & Peds S300001 00700 00600
Total Adults & Peds S300001 00700 00700
Total Adults & Pediatrics S300001 00700 00800
Total Hospital S300001 01400 00200
Total Hospital S300001 01400 00300
Total Hospital S300001 01400 00600
Total Hospital S300001 01400 00700
Total Hospital S300001 01400 00800
Total Hospital Interns & Residents S300001 01400 01000
S300001 01400 01300
S300001 01400 01400 S300001 01400 01400
S300001 01400 01500 S300001 01400 01500
Total Facility S300001 02700 00200
Total Facility FTEs S300001 02700 01000
Medicaid Observation Days S300001 02800 00800
Total Salaries S300002 00100 00200
Total Salaries S300002 00100 00400
Total Salaries S300002 00100 00500
Total Salaries S300002 00100 00600
Contract Labor: Pysician Part A S300002 01300 00200
Contract Labor: Physician Part A S300002 01300 00400
Contract Labor: Physician Part A S300002 01300 00500
Contract Labor: Physician Part A S300002 01300 00600
Wage Related Costs Core S300002 01700 00200
Wage Related Costs Core S300002 01700 00400
Wage Related Costs Other S300002 01800 00200
Wage Related Costs Other S300002 01800 00400
Administrative and General S300002 02700 00200
Administrative and General S300002 02700 00400
Administrative and General S300002 02700 00500
Administrative and General S300002 02700 00600
Administrative & General under contract S300002 02800 00200
Administrative & General under contract S300002 02800 00400
Administrative and General under Contrac S300002 02800 00500
Administrative and General under Contrac S300002 02800 00600
Operation of Plant S300002 03000 00200
Operation of Plant S300002 03000 00400
Operation of Plant S300002 03000 00500
Operation of Plant S300002 03000 00600
Housekeeping under contract S300002 03300 00200
Housekeeping under contract S300002 03300 00400
Housekeeping under Contract S300002 03300 00500
Housekeeping under Contract S300002 03300 00600
Dietary S300002 03400 00200
Dietary S300002 03400 00400
Dietary S300002 03400 00500
Dietary S300002 03400 00600
Nursing Administration S300002 03800 00200
Nursing Administration S300002 03800 00400
Nursing Administration S300002 03800 00500
Nursing Administration S300002 03800 00600
Medical Records & Med Records Library S300002 04100 00200
Medical Records & Med Records Library S300002 04100 00400
Medical Records & Med Records Library S300002 04100 00500
Medical Records & Med Records Library S300002 04100 00600
Net Salaries S300003 00100 00200
Net Salaries S300003 00100 00400
Net Salaries S300003 00100 00500
Net Salaries S300003 00100 00600
Subtotal Salaries S300003 00300 00200
Subtotal Salaries S300003 00300 00400
Subtotal Salaries S300003 00300 00500
Subtotal Salaries S300003 00300 00600
Subtotal Other Wages and Related Csts S300003 00400 00200
Subtotal Other Wages and Related Csts S300003 00400 00400
Subtotal Other Wages and Related Csts S300003 00400 00500
Subtotal Other Wages and Related Csts S300003 00400 00600
Subtotal Wage Related Csts S300003 00500 00200
Subtotal Wage Related Csts S300003 00500 00400
Subtotal Wage Related Csts S300003 00500 00600
Total S300003 00600 00200
Total S300003 00600 00400
Total S300003 00600 00500
Total S300003 00600 00600
Total Overhead Costs S300003 00700 00400
Total Overhead Costs S300003 00700 00500
Total Overhead Costs S300003 00700 00600
Nursery A000000 04300 00100
Nursery A000000 04300 00200
Renal Dialysis A000000 07400 00200
Total A700003 00300 01000
Total A700003 00300 01100
Rental of Provider space by suppliers A800000 00600 00200
Telephone Services A800000 00700 00200
Related Organization Transactions A800000 01200 00200
Cafeteria employees and guests A800000 01400 00200
Nursery B000001 04300 00000
Nursery B000001 04300 02600
Renal Dialysis B000001 07400 00000
Renal Dialysis B000001 07400 02600
Nursery B000002 04300 02600
Renal Dialysis B000002 07400 02600
Total Directly Assigned New Cap Rel Csts B000002 20200 00000
Nursery C000001 04300 00500
Nursery C000001 04300 00600
Renal Dialysis C000001 07400 00500
Renal Dialysis C000001 07400 00600
Renal Dialysis C000001 07400 00700
Nursery D00A181 04300 00400
D00A182 07400 00500
Renal Dialysis D00A185 07400 00200
Renal Dialysis D00A185 07400 00500
Renal Dialysis D30A180 07400 00200
Renal Dialysis D30A180 07400 00300
E00A18A 00200 00100
E00A18A 03500 00100
E00A18A 07500 0010 E00A18A 07500 00100
E00A18B 00400 00100
G200000 01600 00100
G300000 01400 00100
G300000 02000 00100
G300000 02200 00100
HMO S300001 00200 00600
HMO S300001 00200 00700
S300001 00200 01300
Nursery S300001 01300 00700
Nursery S300001 01300 00800
S300001 02800 00700
S300001 03200 00700
S300001 03200 00800
Excluded Area Salaries S300002 01000 00200
Excluded Area Salaries S300002 01000 00400
Excluded Area Salaries S300002 01000 00500
Excluded Area Salaries S300002 01000 00600
Contract Labor S300002 01100 00200
Contract Labor S300002 01100 00400
Contract Labor S300002 01100 00500
Contract Labor S300002 01100 00600
Management and Administrative Services S300002 01200 00200
Management and Administrative Services S300002 01200 00400
Management and Administrative Services S300002 01200 00500
Management and Administrative Services S300002 01200 00600
Excluded Areas S300002 01900 00200
Excluded Areas S300002 01900 00400
Employee Benefits S300002 02600 00200
Employee Benefits S300002 02600 00400
Employee Benefits S300002 02600 00500
Employee Benefits S300002 02600 00600
Dietary under contract S300002 03500 00200
Dietary under contract S300002 03500 00400
Dietary under Contract S300002 03500 00500
Dietary under Contract S300002 03500 00600
Central Services and Supply S300002 03900 00200
Central Services and Supply S300002 03900 00400
Central Services and Supply S300002 03900 00500
Central Services and Supply S300002 03900 00600
Pharmacy S300002 04000 00200
Pharmacy S300002 04000 00400
Pharmacy S300002 04000 00500
Pharmacy S300002 04000 00600
Excluded Area Salaries S300003 00200 00200
Excluded Area Salaries S300003 00200 00400
Excluded Area Salaries S300003 00200 00500
Excluded Area Salaries S300003 00200 00600
Subprovider-IPF A000000 04000 00200
SNF A000000 04400 00100
SNF A000000 04400 00200
Ambulance Services A000000 09500 00100
Ambulance Services A000000 09500 00200
Land Improvements A700001 00200 00100
Land Improvements A700001 00200 00200
Fixed Equipment A700001 00500 00100
Investment Income-New Bldgs & Fixtures A8 A800000 00100 00200
Trade, Quantity, and Time Discounts A800000 00400 00200
Laundry and Linen Service A800000 01300 00200
Sale of medical and surgical supplies to A800000 01600 00200
Subprovider-IPF B000001 04000 00000
Subprovider-IPF B000001 04000 02600
SNF B000001 04400 00000
SNF B000001 04400 02600
Ambulance Services B000001 09500 00000
Ambulance Services B000001 09500 02600
SNF B000002 04400 02600
Ambulance Services B000002 09500 02600
Subprovider-IPF C000001 04000 00500
SNF C000001 04400 00500
SNF C000001 04400 00600
Ambulance Services C000001 09500 00500
Ambulance Services C000001 09500 00600
Ambulance Services C000001 09500 00700
Total Swing Bed Cost D10A181 02600 00100
net of Swing Bed Cost D10B181 02700 00100
net of Swing Bed and Private Room Diff D10B181 03700 00100
net of Swing Bed and Private Room Diff D10E181 03700 00100
Total Program General Inp. Rtn Service D10E181 07400 00100
Program Ancillary Services D10E181 08400 00100
D30E180 20000 00200
TOTAL D30E180 20000 00300
TOTAL D30E180 20200 00200
E00A18A 00300 00100
E00A18A 04800 00100
E00A18A 06300 0010 E00A18A 06300 00100
E20F180 00100 00100
E20F180 00500 00100
E20F180 00800 00100
E20F180 01000 00100
E20F180 01200 00100
E20F180 01300 00100
E20F180 01500 00100
E20F180 01700 00100
E20F180 01900 00100
E20F180 02000 00100
E20F180 02200 00100
E30E186 00100 00100
E30E186 00400 00100
E30E186 00700 00100
E30E186 01200 00100
E30E186 01500 00100
E30E186 01600 00100
G200000 00700 00100
G200000 02300 00100
G200000 02300 00200
G200000 03100 00100
G200000 03600 00200
G300000 01000 00100
G300000 01300 00100
G300000 01600 00100
H310181 00100 00500
H310181 00100 00700
H310181 00200 00500
H310181 00200 00700
H310181 00300 00500
H310181 00300 00700
H310181 00400 00500
H310181 00400 00700
H310181 00500 00500
H310181 00500 00700
H310181 00600 00500
H310181 00600 00700
H310181 00700 00700
H410182 01100 00200
H410182 01200 00200
H410182 01300 00200
H410182 01400 00200
H410182 01600 00200
H410182 01700 00200
H410182 02200 00200
H410182 02400 00200
H410182 02600 00200
H410182 02900 00200
H410182 03000 00200
H410182 03100 00200
H410182 03200 00200
If (SCH), enter the # of periods. S200001 03500 00100
Hospital Adults & Ped Swing Bed SNF S300001 00500 00600
Hospital Adlts & Ped Swing Bed SNF S300001 00500 00800
Hospital Adlts & Ped Swing Bed NF S300001 00600 00800
SNF S300001 01900 00200
SNF S300001 01900 00300
SNF S300001 01900 00600
SNF S300001 01900 00800
SNF S300001 01900 01000
Ambulance Trips S300001 02900 00600
Non-Physician Anesthetist Part B S300002 00300 00200
Non-Physician Anesthetist Part B S300002 00300 00400
Non-Physician Anesthetist Part B S300002 00300 00500
Non-Physician Anesthetist Part B S300002 00300 00600
Physician-Part A S300002 00400 00200
Physician-Part A S300002 00400 00400
Physician-Part A S300002 00400 00500
Physician-Part A S300002 00400 00600
Physician-Part B S300002 00500 00200
Physician-Part B S300002 00500 00400
Physician-Part B S300002 00500 00500
Physician-Part B S300002 00500 00600
Non-Physician Part B S300002 00600 00200
Non-Physician Part B S300002 00600 00400
Non-Physician Part B S300002 00600 00500
Non-Physician Part B S300002 00600 00600
SNF S300002 00900 00200
SNF S300002 00900 00400
SNF S300002 00900 00500
SNF S300002 00900 00600
Non-Physician Anesthetist Part B S300002 02100 00200
Non-Physician Anesthetist Part B S300002 02100 00400
Physician Part A S300002 02200 00200
Physician Part A S300002 02200 00400
Physician Part B S300002 02300 00200
Physician Part B S300002 02300 00400
Wage Related Costs RHC/FQHC S300002 02400 00200
Wage Related Costs RHC/FQHC S300002 02400 00400
Maintenance and Repairs S300002 02900 00200
Admin & Gen Under Contract S300002 02900 00400
Admin & Gen Under Contract S300002 02900 00500
Admin & Gen Under Contract S300002 02900 00600
Laundry and Linen Service S300002 03100 00200
Laundry and Linen Service S300002 03100 00400
Laundry and Linen Service S300002 03100 00500
Laundry and Linen Service S300002 03100 00600
Housekeeping S300002 03200 00200
Housekeeping S300002 03200 00400
Housekeeping S300002 03200 00500
Housekeeping S300002 03200 00600
Cafeteria S300002 03600 00400
Cafeteria S300002 03600 00500
Cafeteria S300002 03600 00600
Without Outliers: Total Visits S410000 03300 00100
With Outliers: Total Visits S410000 03300 00200
LUPA Episodes: Total Visits S410000 03300 00300
PEP Episodes: Total Visits S410000 03300 00400
Total Visits S410000 03300 00500
Without Outliers: Total Charges S410000 03500 00100
With Outliers: Total Charges S410000 03500 00200
Total Charges: LUPA Episodes S410000 03500 00300
PEP Episodes: Total Charges: S410000 03500 00400
Total Charges S410000 03500 00500
W/Out Outliers: Number of Episodes S410000 03600 00100
LUPA Episodes: Total Number of Episod S410000 03600 00300
PEP Episodes: Total Number of Episode S410000 03600 00400
Total Number of Episodes S410000 03600 00500
With Outliers: Number of Episodes S410000 03700 00200
PEP: Total Number of Outlier Episodes S410000 03700 00400
Total Number of Outlier Episodes S410000 03700 00500
With Outliers: Non Routine Med Sup Ch S410000 03800 00200
LUPA: Total Non Routine Med Sup Chgs S410000 03800 00300
PEP: Total Non Routine Med Supply Chg S410000 03800 00400
Total Non Routine Medical Supply Char S410000 03800 00500
Other Capital A000000 00300 00200
Buildings and Fixtures A700001 00300 00200
Total A700003 00300 00500
Total A700003 00300 00600
Building Improvements A700001 00400 00200
Fixed Equipment A700001 00500 00200
E30A182 00100 00100
E30A182 00900 00100
E30A182 01200 00100
E30A182 01600 00100
E30A182 01800 00100
E30A182 01900 00100
E30A182 02000 00100
E30A182 02100 00100
E30A182 02200 00100
E30A182 02600 00100
E30A182 03100 00100
E30A182 03200 00100
Depreciation-New Movable Equipment A800000 02700 00200
Nursery A000000 04300 00600
Interest Expense A000000 11300 00600
Buildings and Fixtures A700001 00300 00500
Building Improvements A700001 00400 00500
Fixed Equipment A700001 00500 00500
Movable Equipment A700001 00600 00500
Subtotal A700001 00800 00500
Total A700001 01000 00500
Non-physician Anesthetist A800000 02800 00200
E00A18B 04400 00100
Hospital Adults & Pediatrics S300001 00100 00500
S300001 00100 01200
Total Hospital S300001 00700 00500
Nursery S300001 01300 00500
Total Hospital S300001 01400 00500
S300001 01400 01200
S300001 03000 00800
Home Office Personnel S300002 00800 00200
Home Office Personnel S300002 00800 00400
Home Office Personnel S300002 00800 00500
Home Office Personnel S300002 00800 00600
Social Service S300002 04200 00200
Social Service S300002 04200 00400
Social Service S300002 04200 00500
Social Service S300002 04200 00600
Subprovider-IPF A000000 04000 00100
Subprovider-IPF A000000 04000 00600
Renal Dialysis A000000 07400 00600
Land Improvements A700001 00200 00700
Buildings and Fixtures A700001 00300 00700
Building Improvements A700001 00400 00700
Fixed Equipment A700001 00500 00700
Movable Equipment A700001 00600 00700
Subtotal A700001 00800 00700
Total A700001 01000 00700
Subprovider-IPF B000002 04000 02600
Subprovider-IPF C000001 04000 00600
Subprovider-IPF D00A181 04000 00400
Subprovider-IPF D00A181 04000 00600
Subprovider-IPF D00A181 04000 00700
Total D00A185 20000 00300
Total D00A185 20000 00600
D00B182 20000 00500
Total Program General Inpatient Routine D10B181 04100 00100
Program Inpatient Ancillary Service Cost D10B181 04800 00100
Total Program Inpatient Costs D10B181 04900 00100
Pass through Cost for Program Inpatient D10B181 05000 00100
Pass Through Cost for Program Ancillary D10B181 05100 00100
Total Program Excludable Costs D10B181 05200 00100
Anesthetist, and Medical Education Costs D D10B181 05300 00100
Subprovider-IPF D30B180 04000 00200
TOTAL D30B180 20000 00200
TOTAL D30B180 20000 00300
E00A18B 02500 00100
E00A18B 03100 00100
E00B18B 00100 00100
E00B18B 00200 00100
E00B18B 00300 00100
E00B18B 01100 00100
E00B18B 01400 00100
E00B18B 01800 00100
E00B18B 01900 00100
E00B18B 02100 00100
E00B18B 02400 00100
E00B18B 02600 00100
E00B18B 02700 00100
E00B18B 03000 00100
E00B18B 03200 00100
E00B18B 03700 00100
E00B18B 04000 00100
E00B18B 04100 00100
E00B18B 04300 00100
E30B182 00100 00100
E30B182 00200 00100
E30B182 00300 00100
E30B182 00900 00100
E30B182 01200 00100
E30B182 01600 00100
E30B182 01800 00100
E30B182 01900 00100
E30B182 02000 00100
E30B182 02100 00100
E30B182 02200 00100
E30B182 02600 00100
E30B182 03100 00100
E30B182 03200 00100
E30B182 03500 00100
G200000 00200 00100
G300000 01200 00100
G300000 01900 00100
IPF S300001 01600 00300
IPF S300001 01600 00600
IPF S300001 01600 00800
S300001 01600 01000
S300001 01600 01300
S300001 01600 01500 S300001 01600 01500
Home Office: Physician Part A S300002 01500 00200
Home Office: Physician Part A S300002 01500 00400
Home Office: Physician Part A S300002 01500 00500
Home Office: Physician Part A S300002 01500 00600
Television and Radio Service A800000 00800 00200
Depreciation-New Bldgs & Fixtures A800000 02600 00200
E00A18A 06000 00100
G200000 03000 00100
G300000 01100 00100
Subprovider-IRF A000000 04100 00100
Subprovider-IRF A000000 04100 00200
Subprovider-IRF A000000 04100 00600
Renal Dialysis A000000 07400 00100
Parking Lot A800000 00900 00200
Income from imposition of interest, finan A800000 02100 00200
Subprovider-IRF B000001 04100 00000
Subprovider-IRF B000001 04100 02600
Subprovider-IRF B000002 04100 02600
Subprovider-IRF C000001 04100 00500
Subprovider-IRF C000001 04100 00600
Subprovider-IRF D00A181 04100 00400
Subprovider-IRF D00A181 04100 00600
Subprovider-IRF D00A181 04100 00700
D00C182 07400 00500
D00C182 20000 00500
net of Swing Bed Cost D10C181 02700 00100
net of Swing Bed and Private Room Diff D10C181 03700 00100
Total Program General Inpatient Routine D10C181 04100 00100
Program Inpatient Ancillary Service Cost D10C181 04800 00100
Total Program Inpatient Costs D10C181 04900 00100
Pass through Cost for Program Inpatient D10C181 05000 00100
Pass Through Cost for Program Ancillary D10C181 05100 00100
Total Program Excludable Costs D10C181 05200 00100
Anesthetist, and Medical Education Costs D D10C181 05300 00100
Subprovider-IRF D30C180 04100 00200
Renal Dialysis D30C180 07400 00200
Renal Dialysis D30C180 07400 00300
TOTAL D30C180 20000 00200
TOTAL D30C180 20000 00300
E00C18B 00100 00100
E00C18B 00200 00100
E00C18B 00300 00100
E00C18B 01100 00100
E00C18B 01400 00100
E00C18B 01800 00100
E00C18B 01900 00100
E00C18B 02100 00100
E00C18B 02400 00100
E00C18B 02600 00100
E00C18B 02700 00100
E00C18B 03000 00100
E00C18B 03200 00100
E00C18B 03700 00100
E00C18B 04000 00100
E00C18B 04100 00100
E00C18B 04300 00100
E30C183 00100 00100
E30C183 00200 00100
E30C183 00300 00100
E30C183 00400 00100
E30C183 01000 00100
E30C183 01300 00100
E30C183 01700 00100
E30C183 01900 00100
E30C183 02000 00100
E30C183 02100 00100
E30C183 02200 00100
E30C183 02300 00100
E30C183 02700 00100
E30C183 03200 00100
E30C183 03300 00100
E30C183 03500 00100
E30C183 03600 00100
E30C183 05000 00100
G200000 00300 00100
G300000 02700 00100
G300000 02800 00100
S300001 00400 00600
S300001 00400 00700
IRF S300001 01700 00300
IRF S300001 01700 00600
IRF S300001 01700 00800
S300001 01700 01000
S300001 01700 01300
S300001 01700 01500 S300001 01700 01500
S300001 03100 00800
SNF A000000 04400 00600
Investment Income-New Movable Equip A800000 00200 00200
Adults and Pediatrics D30E180 03000 00200
E30E186 00800 00100
E30E186 00900 00100
E30E186 01000 00100
E30E186 01800 00100
SNF S300001 01900 00700
Refunds and Rebates of Expenses A800000 00500 00200
E00A18B 03800 00100
E20F180 00300 00100
Hospital Adults & Pediatrics S300001 00100 00400
Total Hospital S300001 00700 00400
Total Hospital S300001 01400 00400
IPF S300001 01600 00700
S300001 01600 01400 S300001 01600 01400
Ambulance Services A000000 09500 00600
Kidney Acquisition A000000 10500 00100
Kidney Acquisition A000000 10500 00200
Kidney Acquisition A000000 10500 00600
Kidney Acquisition B000001 10500 00000
Kidney Acquisition B000001 10500 02600
Kidney Acquisition B000002 10500 02600
Kidney Acquisition C000001 10500 00500
Kidney Acquisition C000001 10500 00600
E00A18A 05500 00100
Sale of drugs to other than patients A800000 01700 00200
G300000 01700 00100
Negative Cost Centers B000002 20100 02600
Adults and Pediatrics B000001 03000 02200
Pancreas Acquisition B000001 10900 00000
Pancreas Acquisition B000001 10900 02600
Pancreas Acquisition B000002 10900 02600
Cross Foot Adjustments B000002 20000 02600
Pancreas Acquisition C000001 10900 00500
Adults & Pediatrics D00A183 03000 00900
Subprovider-IPF D00A183 04000 00900
Total Allied Health Cost D00A183 20000 00200
Total Costs D00A183 20000 00500
Total D00A183 20000 00900
Total Allied Health D00A184 20000 00300
Total Outpatient Program Pass Thru Cost D00A184 20000 00600
Total D00A184 20000 01100
Total D00A184 20000 01300
Subprovider-IPF D30A180 04000 00200
E00A18A 00500 00100
E00A18A 00700 00100
E00A18A 00900 00100
E00A18A 01000 00100
E00A18A 01100 00100
E00A18A 01200 00100
E00A18A 01300 00100
E00A18A 01400 00100
E00A18A 01500 00100
E00A18A 01800 00100
E00A18A 01900 00100
E00A18A 02000 00100
E00A18A 02100 00100
E00A18A 02200 00100
E00A18A 02300 00100
E00A18A 02400 00100
E00A18A 02500 00100
E00A18A 02600 00100
E00A18A 02700 00100
E00A18A 02800 00100
E00A18A 02900 00100
E00A18A 05200 00100
E00A18A 05300 00100
E00A18A 05700 00100
E00A18A 05800 00100
E00A18B 00900 00100
E00A18B 02800 00100
E30B182 02800 00100
E30B182 03400 00100
E40A180 00100 00100
E40A180 00300 00100
E40A180 00500 00100
E40A180 00600 00100
E40A180 00700 00100
E40A180 00800 00100
E40A180 00800 00200
E40A180 00800 00300 E40A180 00800 00300
E40A180 00900 00100
E40A180 00900 00200
E40A180 00900 00300 E40A180 00900 00300
E40A180 01000 00200
E40A180 01100 00100
E40A180 01100 00200
E40A180 01200 00100
E40A180 01200 00200
E40A180 01300 00100
E40A180 01300 00200
E40A180 01400 00100
E40A180 01400 00200
E40A180 01700 00100
E40A180 01700 00200
E40A180 01800 00100
E40A180 01800 00200 E40A180 01800 00200
E40A180 01900 00100
E40A180 01900 00200 E40A180 01900 00200
E40A180 01900 00300 E40A180 01900 00300
E40A180 02000 00100
E40A180 02200 00100
E40A180 02300 00100
E40A180 02400 00100
E40A180 02500 00100
E40A180 02600 00100
E40A180 02600 00200 E40A180 02600 00200
E40A180 02700 00100
E40A180 02700 00200 E40A180 02700 00200
E40A180 02800 00100
E40A180 02800 00200 E40A180 02800 00200
E40A180 02900 00100
E40A180 02900 00200 E40A180 02900 00200
E40A180 03000 00200 E40A180 03000 00200
E40A180 03100 00300 E40A180 03100 00300
E40A180 03300 00100
E40A180 03700 00100
E40A180 03800 00100
E40A180 04000 00100
E40A180 04100 00100
E40A180 04200 00100
E40A180 04300 00100
E40A180 04400 00100
E40A180 04500 00100
E40A180 04600 00100
E40A180 04700 00100
E40A180 04800 00100
E40A180 04900 00100
E40A180 05000 00100
S300001 00300 00600
Total Hospital Interns & Residents S300001 01400 00900
Total Facility FTEs S300001 02700 00900
end of cost reporting period S500000 00100 00100
end of cost reporting period S500000 00100 00600
receives Dialysis S500000 00200 00100
Patient receives Dialysis S500000 00200 00600
including setup S500000 00300 00100
furnished S500000 00500 00100
Number of stations S500000 00600 00100
station S500000 00700 00100
list S500000 01100 00100
during fiscal year S500000 01200 00100
E20F180 01100 00100
G200000 00500 00100
G300000 01500 00100
E30B182 02300 00100
E30B182 02400 00100
E30B182 02500 00100
Land Improvements A700001 00200 00500
Adults and Pediatrics B000001 03000 02100
Total Allied Health D00C184 20000 00300
Total Outpatient Program Pass Thru Cost D00C184 20000 00600
Total D00C184 20000 01100
E30C183 00500 00100
E30C183 02900 00100
E40A180 00301 00100
IRF S300001 01700 00700
S300001 01700 01400 S300001 01700 01400
Interns & Residents S300002 00700 00200
Interns & Residents S300002 00700 00400
Interns & Residents S300002 00700 00500
Interns & Residents S300002 00700 00600
Interns & Residents S300002 02500 00200
Interns & Residents S300002 02500 00400
Other General Service S300002 04300 00200
Other General Service S300002 04300 00400
Other General Service S300002 04300 00500
Other General Service S300002 04300 00600
E00A18A 00800 00100
E00A18A 00802 00100
E40A180 00400 00100
E40A180 00402 00100
G300000 00800 00100
Land A700001 00100 00200
Hospital Adlts & Ped Swing Bed NF S300001 00600 00700
Sale of scrap, waste, etc. A800000 01100 00200
E00A18B 02000 00100
H410182 01500 00200
S300001 00300 00700
E30A184 00100 00100
E30A184 00200 00100
E30A184 00300 00100
E30A184 00700 00100
E30A184 00900 00100
E30A184 01000 00100
E30A184 01100 00100
E30A184 01200 00100
E30A184 01300 00100
E30A184 01400 00100
E30A184 01500 00100
E30A184 01600 00100
E30A184 01700 00100
E30A184 02200 00100
E30A184 02300 00100
E30A184 02500 00100
E30A184 05000 00100
Land Improvements A700001 00200 00300
Fixed Equipment A700001 00500 00300
Movable Equipment A700001 00600 00300
Subtotal A700001 00800 00300
Total A700001 01000 00300
status S200001 03700 00100
Other Capital A000000 00300 00600
E30A183 00100 00100
E30A183 00300 00100
E30A183 01000 00100
E30A183 01300 00100
E30A183 01700 00100
E30A183 01900 00100
E30A183 02000 00100
E30A183 02100 00100
E30A183 02200 00100
E30A183 02300 00100
E30A183 02700 00100
E30A183 03200 00100
E30A183 03300 00100
E30A183 03500 00100
Rental of quarters to employee and oths A800000 01500 00200
Land A700001 00100 00500
E30C183 02400 00100
E30C183 02500 00100
E00A18A 00600 00100
E40A180 00200 00100
Teaching Physician Salaries S300002 01600 00200
Teaching Physician Salaries S300002 01600 00400
Teaching Physician Salaries S300002 01600 00500
Teaching Physician Salaries S300002 01600 00600
Interest expense on Medicare Overpaymts A A800000 02200 00200
Subprovider-IRF B000001 04100 02100
Subprovider-IRF B000001 04100 02200
E30B182 01700 00100
E30C183 00600 00100
E30C183 00700 00100
E30C183 00900 00100
E30C183 01100 00100
E30C183 01200 00100
E30C183 02600 00100
S300001 01700 00900
E30E186 01300 00100
E30E186 01900 00100
E30A183 00200 00100
E30A183 02400 00100
E30A183 02500 00100
E30A183 02600 00100
Ambulance Services D00A185 09500 00300
Ambulance Services D00A185 09500 00600
Negative Cost Centers B000001 20100 02600
E00A18A 00701 00100
G200000 03800 00100
G200000 04200 00200
Nursery B000001 04300 02100
Nursery B000001 04300 02200
E00A18A 05400 00100
E30C183 01800 00100
Renal Dialysis D00A184 07400 00300
Renal Dialysis D00A184 07400 01100
Renal Dialysis D00A184 07400 01300
G200000 03900 00100
end of cost reporting period S500000 00100 00400
CAPD exchanges per day S500000 00400 00400
Total Allied Health D00B184 20000 00300
Total Outpatient Program Pass Thru Cost D00B184 20000 00600
Total D00B184 20000 01100
Total D00B184 20000 01300
Total D00C184 20000 01300
Total D00E184 20000 01100
E00B18B 00400 00100
E00B18B 00900 00100
E00C18B 00900 00100
E00E18B 00100 00100
E00E18B 01100 00100
E00E18B 01400 00100
E00E18B 01800 00100
E00E18B 01900 00100
E00E18B 02100 00100
E00E18B 02500 00100
E00E18B 02700 00100
E00E18B 03000 00100
E00E18B 03200 00100
E00E18B 03700 00100
E00E18B 04000 00100
E00E18B 04100 00100
E00E18B 04300 00100
E30E186 00300 00100
Total D00A184 20000 00100
D00B182 07400 00500
Renal Dialysis D30B180 07400 00200
Renal Dialysis D30B180 07400 00300
E00B18B 03400 00100
E00B18B 03500 00100
E30A182 02300 00100
E30A182 02400 00100
E30A182 02500 00100
E30A182 03400 00100
Renal Dialysis B000001 07400 02100
Physicians' Assistant A800000 02900 00200
Non-Physician Anesthetist Part A S300002 00200 00200
Non-Physician Anesthetist Part A S300002 00200 00400
Non-Physician Anesthetist Part A S300002 00200 00500
Non-Physician Anesthetist Part A S300002 00200 00600
Non-Physician Anesthetist Part A S300002 02000 00200
Non-Physician Anesthetist Part A S300002 02000 00400
E30A184 01800 00100
OLTC A000000 04600 00100
OLTC A000000 04600 00200
OLTC A000000 04600 00600
Nursing School A800000 01900 00200
OLTC B000001 04600 00000
OLTC B000001 04600 02600
OLTC B000002 04600 02600
OLTC C000001 04600 00600
E20F180 01800 00100
G200000 00900 00100
OLTC S300001 02100 00200
OLTC S300001 02100 00300
OLTC S300001 02100 00800
OLTC S300001 02100 01000
S300001 02100 01500 S300001 02100 01500
Subprovider-IPF B000001 04000 02100
Subprovider-IPF B000001 04000 02200
S300001 01600 00900
E00A18A 04000 00100
E00A18A 04100 00100
E00A18A 04200 00100
E00A18A 04300 00100
E00A18A 04400 00100
E00A18A 04500 00100
SNF B000001 04400 02200
SNF D00A183 04400 00900
Total Nursing School D00A184 20000 00200
Total Nursing School D00B184 20000 00200
E30E186 00200 00100
SNF S300001 01900 00900
E40A180 03500 00100
E30A183 00400 00100
E30A183 05000 00100
Cafeteria S300002 03600 00200
Renal Dialysis D30E180 07400 00200
Renal Dialysis D30E180 07400 00300
E00A18A 01600 00100
E40A180 01500 00100
H320181 00100 00500
H320181 00100 00700
H320181 00200 00500
H320181 00200 00700
H320181 00300 00500
H320181 00300 00700
H320181 00400 00500
H320181 00400 00700
H320181 00500 00500
H320181 00500 00700
H320181 00600 00500
H320181 00600 00700
H320181 00700 00700
H420182 01100 002 H420182 01100 00200
H420182 01200 002 H420182 01200 00200
H420182 01300 002 H420182 01300 00200
H420182 01400 002 H420182 01400 00200
H420182 01500 002 H420182 01500 00200
H420182 02200 002 H420182 02200 00200
H420182 02400 002 H420182 02400 00200
H420182 02600 002 H420182 02600 00200
H420182 02900 002 H420182 02900 00200
H420182 03100 002 H420182 03100 00200
H420182 03200 002 H420182 03200 00200
Without Outliers: Total Visits S420000 03300 00100
With Outliers: Total Visits S420000 03300 00200
LUPA Episodes: Total Visits S420000 03300 00300
PEP Episodes: Total Visits S420000 03300 00400
Total Visits S420000 03300 00500
Without Outliers: Total Charges S420000 03500 00100
With Outliers: Total Charges S420000 03500 00200
Total Charges: LUPA Episodes S420000 03500 00300
PEP Episodes: Total Charges: S420000 03500 00400
Total Charges S420000 03500 00500
W/Out Outliers: Number of Episodes S420000 03600 00100
LUPA Episodes: Total Number of Episod S420000 03600 00300
PEP Episodes: Total Number of Episode S420000 03600 00400
Total Number of Episodes S420000 03600 00500
With Outliers: Number of Episodes S420000 03700 00200
Total Number of Outlier Episodes S420000 03700 00500
With Outliers: Non Routine Med Sup Ch S420000 03800 00200
LUPA: Total Non Routine Med Sup Chgs S420000 03800 00300
Total Non Routine Medical Supply Char S420000 03800 00500
Renal Dialysis D00A185 07400 00300
Renal Dialysis D00A185 07400 00400
Renal Dialysis D00A185 07400 00600
Renal Dialysis D00A185 07400 00700
end of cost reporting period S500000 00100 00200
Patient receives Dialysis S500000 00200 00200
including setup S500000 00300 00200
Number of stations S500000 00600 00200
station S500000 00700 00200
E20F180 02300 00100
Renal Dialysis B000001 07400 02200
E00A18B 01200 00100
E00B18B 00500 00100
E00B18B 00600 00100
E00B18B 01200 00100
G300000 00900 00100
G200000 00600 00100
RPCH/CAH Visits S300001 01500 00600
CAH Visits S300001 01500 00800
G200000 03700 00100
E00C18B 01200 00100
furnished S500000 00500 00200
Total Nursing School D00C184 20000 00200
E00A18A 00801 00100
E40A180 00401 00100
E00A18B 04200 00100
E20F180 02100 00100
Home Program Dialysis A000000 09400 00100
Home Program Dialysis A000000 09400 00200
Home Program Dialysis B000001 09400 00000
Home Program Dialysis B000001 09400 02600
Home Program Dialysis B000002 09400 02600
Home Program Dialysis C000001 09400 00500
Home Program Dialysis C000001 09400 00600
Home Program Dialysis C000001 09400 00700
E00E18B 01200 00100
S300001 02300 01000
CAPD exchanges per day S500000 00400 00600
Utilization S500000 00800 00200
Kidney Acquisition B000001 10500 02100
Kidney Acquisition B000001 10500 02200
Kidney Acquisition C000001 10500 00700
E30B182 00400 00100
E30B182 00600 00100
E30B182 00800 00100
E30B182 01000 00100
E30B182 01100 00100
E00E18B 02000 00100
RPCH/CAH Visits S300001 01500 00700
Without Outliers: Other Charges S410000 03400 00100
With Outliers: Other Charges S410000 03400 00200
LUPA Episodes: Other Charges S410000 03400 00300
PEP Episodes: Other Charges S410000 03400 00400
Total Other Charges S410000 03400 00500
E30A182 00200 00100
G200000 03200 00100
E30A183 01800 00100
E30A183 03600 00100
Total A700003 00300 00700
E30A182 01700 00100
E00B18B 00700 00100
H410182 03400 00200
Land A700001 00100 00700
Subprovider I A000000 04200 00100
Subprovider I A000000 04200 00200
Building Improvements A700001 00400 00300
Subprovider I B000001 04200 00000
Subprovider I B000001 04200 02600
Subprovider I B000002 04200 02600
Subprovider I C000001 04200 00500
Subprovider I C000001 04200 00600
Subprovider I D00A181 04200 00400
G200000 00400 00100
Subprovider 1 S300001 01800 00200
Subprovider 1 S300001 01800 00300
Subprovider 1 S300001 01800 00800
Total Subprovider I Interns & Residents S300001 01800 01000
S300001 01800 01500 S300001 01800 01500
OLTC C000001 04600 00500
S300001 03300 00600
S300001 01500 00500
NF A000000 04500 00100
NF A000000 04500 00200
NF B000001 04500 00000
NF B000001 04500 02600
NF B000002 04500 02600
NF C000001 04500 00500
NF C000001 04500 00600
G200000 00800 00100
NF S300001 02000 00200
NF S300001 02000 00300
NF S300001 02000 00700
NF S300001 02000 00800
NF S300001 02000 01000
E00A18B 03300 00100
G200000 03500 00100
Adj for Physical therapy costs in excess A800000 02400 00200
H310181 01600 01000
H410182 01000 00200
H410182 02300 00200
Adj for Occupational therapy in excess of A800000 03000 00200
E00A18A 01700 00100
E40A180 01600 00200
Heart Acquisition A000000 10600 00100
Heart Acquisition A000000 10600 00200
Heart Acquisition A000000 10600 00600
Liver Acquisition A000000 10700 00100
Liver Acquisition A000000 10700 00200
Lung Acquisition A000000 10800 00200
Pancreas Acquisition A000000 10900 00100
Pancreas Acquisition A000000 10900 00200
Intestinal Acquisition A000000 11000 00200
Buildings and Fixtures A700001 00300 00300
Int & Res (non approved teaching progr B000001 10000 00000
Int & Res (non approved teaching progr B000001 10000 02600
Heart Acquisition B000001 10600 00000
Heart Acquisition B000001 10600 02600
Liver Acquisition B000001 10700 00000
Liver Acquisition B000001 10700 02600
Lung Acquisition B000001 10800 00000
Lung Acquisition B000001 10800 02600
Intestinal Acquisition B000001 11000 00000
Intestinal Acquisition B000001 11000 02600
Int & Res (non approved teaching progr B000002 10000 02600
Heart Acquisition B000002 10600 02600
Liver Acquisition B000002 10700 02600
Lung Acquisition B000002 10800 02600
Intestinal Acquisition B000002 11000 02600
Int & Res (non approved teaching progr C000001 10000 00500
Heart Acquisition C000001 10600 00500
Heart Acquisition C000001 10600 00600
Heart Acquisition C000001 10600 00700
Liver Acquisition C000001 10700 00500
Liver Acquisition C000001 10700 00600
Liver Acquisition C000001 10700 00700
Lung Acquisition C000001 10800 00500
Lung Acquisition C000001 10800 00600
Pancreas Acquisition C000001 10900 00600
Intestinal Acquisition C000001 11000 00500
Intestinal Acquisition C000001 11000 00600
Subprovider-IRF D00A183 04100 00900
E00A18B 02200 00100
E00B18B 02200 00100
E00B18B 03600 00100
E00C18B 00500 00100
E00C18B 00600 00100
E00C18B 02200 00100
E00C18B 03400 00100
E00C18B 03500 00100
E00C18B 03600 00100
E40A180 03200 00100
E40A180 03400 00100
Utilization S500000 00800 00100
E00A18A 06800 0010 E00A18A 06800 00100
E30A184 00800 00100
E30A184 02600 00100
Total Hospital Interns & Residents S300001 01400 01100
Total Facility FTEs S300001 02700 01100
E10A182 00100 00100
E10A182 00200 00100
E10A182 00300 00100
E10A182 00400 00100
E10A182 00500 00100
E10A182 00800 00100
E10A182 03200 00100
Home Program Dialysis A000000 09400 00600
G200000 03300 00100
G200000 03400 00100
G200000 04000 00100
end of cost reporting period S500000 00100 00300
end of cost reporting period S500000 00100 00500
furnished S500000 00200 00500
E00A18B 01500 00100
E00A18B 01600 00100
E00A18B 01700 00100
Subprovider-IRF D30A180 04100 00200
Total Nonphysician Anesthetist Cost D00B184 20000 00100
E20F180 00900 00100
NF A000000 04500 00600
Land A700001 00100 00300
E00C18B 02500 00100
E40A180 01500 00200
Pancreas Acquisition A000000 10900 00600
H310181 00100 00600
H310181 00200 00600
H310181 00300 00600
H310181 00400 00600
H310181 00500 00600
H310181 00600 00600
H310181 00700 00600
H410182 01100 00100
H410182 01200 00100
H410182 01300 00100
H410182 01400 00100
H410182 01500 00100
H410182 01600 00100
H410182 02200 00100
H410182 02400 00100
H410182 02600 00100
H410182 02900 00100
H410182 03000 00100
H410182 03100 00100
H410182 03200 00100
H410182 03400 00100
E40A180 01600 00100
Liver Acquisition A000000 10700 00600
E00B18B 03100 00100
E00A18A 04600 00100
E00B18B 02500 00100
Hospital Adlts & Ped Swing Bed SNF S300001 00500 00700
E30B182 00500 00100
Program Discharges D10A181 05400 00100
Target Amount per Discharge D10A181 05500 00100
Target Amount D10A181 05600 00100
Operating Cost and Target Amount D10A181 05700 00100
Allowable Inpatient Cost Plus Incentive P D10A181 06300 00100
E30A181 00100 00100
E30A181 00400 00100
E30A181 00600 00100
E30A181 00700 00100
E30A181 00800 00100
E30A181 00900 00100
E30A181 01000 00100
E30A181 01400 00100
E30A181 01800 00100
E30A181 01900 00100
E30A181 02100 00100
Total Other Medical Education Cost D00A183 20000 00300
Total Other Medical Education D00A184 20000 00400
Subprovider-IRF D30B180 04100 00200
Subprovider-IRF D30C180 04000 00200
Maintenance of Personnel S300002 03700 00200
Maintenance of Personnel S300002 03700 00400
Maintenance of Personnel S300002 03700 00500
Maintenance of Personnel S300002 03700 00600
Patient receives Dialysis S500000 00200 00400
including setup S500000 00300 00400
Number of stations S500000 00600 00400
Heart Acquisition B000001 10600 02100
Heart Acquisition B000001 10600 02200
E30A182 00300 00100
E30A182 00400 00100
E30A182 00600 00100
E30A182 00800 00100
E30A182 01000 00100
E30A182 01100 00100
E30A182 02700 00100
E30A182 03500 00100
E00E18B 03400 00100
E00E18B 03500 00100
E00E18B 03600 00100
E30A182 02800 00100
E00B18B 04400 00100
OLTC B000001 04600 02100
OLTC B000001 04600 02200
E00A18B 02300 00100
E30A182 01500 00100
E40A180 03900 00100
Int & Res (non approved teaching progr A000000 10000 00100
Int & Res (non approved teaching progr A000000 10000 00200
Lung Acquisition A000000 10800 00100
Lung Acquisition A000000 10800 00600
Int & Res (non approved teaching progr B000001 10000 02100
Int & Res (non approved teaching progr B000001 10000 02200
Renal Dialysis D00C184 07400 01100
E30A184 02400 00100
E30E186 00600 00100
E00C18B 00700 00100
Patient receives Dialysis S500000 00200 00300
Number of stations S500000 00600 00300
H330181 00100 00500
H330181 00100 007 H330181 00100 00700
H330181 00200 00500
H330181 00200 007 H330181 00200 00700
H330181 00600 00500
H330181 00600 007 H330181 00600 00700
H330181 00700 007 H330181 00700 00700
H430182 01100 002 H430182 01100 00200
H430182 01200 002 H430182 01200 00200
H430182 01300 002 H430182 01300 00200
H430182 01400 002 H430182 01400 00200
H430182 01500 002 H430182 01500 00200
H430182 02200 002 H430182 02200 00200
H430182 02400 002 H430182 02400 00200
H430182 02600 002 H430182 02600 00200
H430182 02900 002 H430182 02900 00200
H430182 03100 002 H430182 03100 00200
H430182 03200 002 H430182 03200 00200
Without Outliers: Total Visits S430000 03300 00100
With Outliers: Total Visits S430000 03300 00200
LUPA Episodes: Total Visits S430000 03300 00300
PEP Episodes: Total Visits S430000 03300 00400
Total Visits S430000 03300 00500
Without Outliers: Total Charges S430000 03500 00100
With Outliers: Total Charges S430000 03500 00200
Total Charges: LUPA Episodes S430000 03500 00300
PEP Episodes: Total Charges: S430000 03500 00400
Total Charges S430000 03500 00500
W/Out Outliers: Number of Episodes S430000 03600 00100
LUPA Episodes: Total Number of Episod S430000 03600 00300
PEP Episodes: Total Number of Episode S430000 03600 00400
Total Number of Episodes S430000 03600 00500
With Outliers: Number of Episodes S430000 03700 00200
Total Number of Outlier Episodes S430000 03700 00500
With Outliers: Non Routine Med Sup Ch S430000 03800 00200
LUPA: Total Non Routine Med Sup Chgs S430000 03800 00300
PEP: Total Non Routine Med Supply Chg S430000 03800 00400
Total Non Routine Medical Supply Char S430000 03800 00500
E00C18B 04400 00100
E30C183 01400 00100
E30A181 01100 00100
E30A181 01200 00100
E30A181 01300 00100
IPF S300001 01600 00500
IRF S300001 01700 00500
E00C18B 00400 00100
H410182 03500 00200
E00A18B 00800 00100
E30A181 01500 00100
E30A181 02200 00100
Lung Acquisition C000001 10800 00700
E30B182 00700 00100
including setup S500000 00300 00300
Ambulance Services B000001 09500 02200
E30A181 00200 00100
Adj for Respiratory therapy costs in exce A800000 02300 00200
Intestinal Acquisition A000000 11000 00100
Intestinal Acquisition A000000 11000 00600
Intestinal Acquisition C000001 11000 00700
Renal Dialysis D00A184 07400 00400
Total Other Medical Education D00B184 20000 00400
Total Other Medical Education D00C184 20000 00400
G200000 04100 00100
Bonus Payment D10A181 05800 00100
Liver Acquisition B000001 10700 02100
Liver Acquisition B000001 10700 02200
Islet Acquisition B000001 11100 00000
Islet Acquisition B000001 11100 02600
Islet Acquisition B000002 11100 02600
Islet Acquisition C000001 11100 00500
D00A182 09400 00500
Home Program Dialysis D00A184 09400 00300
D00B182 09400 00500
Home Program Dialysis D30A180 09400 00200
Home Program Dialysis D30A180 09400 00300
Home Program Dialysis D30B180 09400 00200
Home Program Dialysis D30B180 09400 00300
E30C183 03000 00100
E30C183 05100 00100
E00E18B 04400 00100
SNF B000001 04400 02100
Ambulance Services B000001 09500 02100
Adj for Speech therapy in excess of lim A800000 03100 00200
E30A182 00700 00100
Utilization Review SNF A000000 11400 00600
Utilization Review-physicians compens A800000 02500 00200
Utilization Review - Physician Compen D10E181 08500 00100
E30E186 01100 00100
E00E18B 01600 00100
Int & Res (non approved teaching progr A000000 10000 00600
E10A182 03000 00100
Average times dialyzers re-used S500000 00900 00100
Average times dialyzers re-used S500000 00900 00200
dialyzers S500000 01000 00100
dialyzers S500000 01000 00200
Hospital Street Address S200001 00100 00100
Hospital City S200001 00200 00100
Hospital State S200001 00200 00200
Hospital Zip Code S200001 00200 00300
Hospital County S200001 00200 00400
Hospital Name S200001 00300 00100
Provider's actual MSA or CBSA S200001 00300 00300
Hospital Title 18 Payment System (P/T/O) S200001 00300 00700
Swing Bed SNF Provider Number S200001 00700 00200
accordance with 42 CFR 412.320?(Y/N/P) S200001 02200 00100
(Y/N) S200001 04700 00100
costs? (Y/N) S200001 04800 00100
affiliated with a teaching hospital? (Y/N) S200001 05600 00100
or allied health costs? S200001 06000 00100
413.40(f)(1)(I) (TEFRA)? (Y/N) S200001 08500 00100
facility for purposes of Title XIX? (Y/N) S200001 09300 00100
(Y/N) S200001 10500 00100
schedule? (Y/N) S200001 10800 00100
provider? (Y/N) S200001 11500 00100
center? (Y/N) S200001 11600 00100
transplant center? (Y/N) S200001 12500 00100
Pub. 15-I, chapter 10? (Y/N) S200001 14000 00100
included in Worksheet A? (Y/N) S200001 14400 00100
Hospital PO Box S200001 00100 00200
FI/Contractor's Name S200001 14000 00200
Home Office Name S200001 14100 00100
Home Office Street S200001 14200 00100
City S200001 14300 00100
State S200001 14300 00200
Zip Code S200001 14300 00300
inpatient services only? (Y/N) S200001 14500 00100
IPF Provider Number S200001 00400 00200
SNF Provider Number S200001 00900 00200
HHA 1 Provider Number S200001 01200 00200
Hospice 1 Provider Number S200001 01400 00200
RHC 1 Provider Number S200001 01500 00200
Beginning Date of SCH status S200001 03600 00100
Ending Date of SCH status S200001 03600 00200
S200001 10700 00100
for outpatient service? (Y/N) S200001 10600 00100
IRF Provider Number S200001 00500 00200
transplant center cert date S200001 12600 00100
Home Office PO Box S200001 14200 00200
RHC 2 Provider Number S200001 01501 00200
RHC 3 Provider Number S200001 01502 00200
Renal 1 Provider Number S200001 01800 00200
transplant center cert date S200001 12800 00100
Medicare Certified Liver TC term date S200001 12800 00200
MCP Physician Payment Method (Y/N) S500000 02100 00100
Swing Bed NF Provider Number S200001 00800 00200
RHC 4 Provider Number S200001 01503 00200
MDH status beginning date (MM/DD/YY) S200001 03800 00100
MDH status ending date (MM/DD/YY) S200001 03800 00200
RHC 5 Provider Number S200001 01504 00200
Initial Physician Payment Method (Y/N) S500000 02100 00200
HHA 2 Provider Number S200001 01201 00200
used: (A, B, or E only) S200001 11500 00200
NF Provider Number S200001 01000 00200
CMHC 1 Provider Number S200001 01700 00200
transplant center cert date S200001 12700 00100
transplant center cert date S200001 12900 00100
certification date S200001 13100 00100
Renal 2 Provider Number S200001 01801 00200
Renal 3 Provider Number S200001 01802 00200
Renal 4 Provider Number S200001 01803 00200
Renal 5 Provider Number S200001 01804 00200
Renal 6 Provider Number S200001 01805 00200
Medicare Certified Pancreas TC term date S200001 13000 00200
FQHC 1 Provider Number S200001 01600 00200
FQHC 2 Provider Number S200001 01601 00200
HHA 3 Provider Number S200001 01202 00200
RHC 6 Provider Number S200001 01505 00200
certification date S200001 13200 00100
RHC 7 Provider Number S200001 01506 00200
RHC 8 Provider Number S200001 01507 00200
RHC 9 Provider Number S200001 01508 00200
RHC 10 Provider Number S200001 01509 00200
Provider Control Type Code
Provider Number
Report Status Code
Initial Report Switch
Last Report Switch
Transmittal Number
Fiscal Intermediary Number
Automated Desk Review Vendor Code
Utilization Code
Special Indicator
National Provider Identifier
Fiscal Year Begin Date
Fiscal Year End Date
HCRIS Process Date
Fiscal Intermediary Create Date
Notice of Program Reimbursement Date
Fiscal Intermediary Receipt Date