Medicare Financial Management Manual (Pub. 100-06), Ch. 1 § 150.1
Completing the Schedule of Other Adjustments (Schedule D) -
150.1 - Completing the Schedule of Other Adjustments (Schedule D) -
(Rev. 1, 08-30-02)
A1-1218.1, B1-4218.1
A. General
The contractor shall use this schedule to identify specific Other Adjustments included in
the Other Adjustments line of the Activity Screen as defined in §90.9L. A separate
Schedule D is completed for each activity requiring the specific identification of Other
Adjustments.
B. Uses
The contractor shall complete this schedule only with the concurrence of CMS. It may
not be required of all contractors. Although described in this section, the schedule will
not be used in budget preparation. It may be used for the IER and/or FACP.
C. Explanation of Entries on the Schedule D
1. Code - A three-digit code identifying each adjustment item. The contractor shall use
999 to identify all remaining adjustments not requiring specific identification.
2. Description - A brief description of the adjustment item. Types of adjustments to be
reported are described in §90.9 L. Those items requiring identification will depend on the
nature of the contractor's contract, materiality and other considerations.
3. Total Adjustments - The contractor shall report the total adjustment for each item.
The total for all Other Adjustments, including those reported under 999 if applicable,
must agree with the total reported on the Other Adjustments line of the Activity Screen.