Filing Requirements for Providers Using Form CMS-2552

40 - Filing Requirements for Providers Using Form CMS-2552 (Rev. 4, 10-01-01) Providers using Form CMS-2552 will prepare their cost reports and submit them to the FFS system just as they now do, except that the cost of only Medicare patients who are not members of the HMO/CMP will be apportioned and submitted to the FFS system for payment. When an HMO/CMP has elected to have CMS process the bills for some hospitals and SNFs furnishing services to the organization’s Medicare enrollees, the affected providers will prepare their cost reports and submit them to the FFS system just as they do now. The cost of the organization’s enrollees should be included with the provider’s other Medicare patients, apportioned, and submitted to the intermediary for payment. In addition, the provider will prepare a separate set of apportionment and settlement worksheets apportioning the costs to the organization’s Medicare enrollees. A separate set of worksheets will be needed for each organization with which the provider has an agreement to have payment made directly by the HMO/CMP. Each set of worksheets will apportion each cost center between the applicable group of Medicare beneficiaries and all other provider patients. For example, HMO A has a bill processing contract with the provider. The provider will submit to the HMO the set of worksheets which will reflect the cost of providing covered services to the HMO’s Medicare enrollees. The apportionment ratios by cost center would be: (Total Costs) times (Charges for the HMO’s Medicare enrollees) = Total Charges Ratios by cost centers on the worksheets for non-HMO/CMP Medicare patients would be: (Total Costs) times (Charges for Medicare patients that are not members of the HMO/CMP) = Total Charges All other schedules currently required will be completed under existing instructions. Copies of all schedules will be sent to the FFS system for processing and settlement.