Checking Reports

110 – Checking Reports (Rev. 45, 05-28-04) Before you send the report to CMS, check for completeness and arithmetical accuracy. Use the following checklist for an arithmetical check for each column: o Column 1 = Column 2 + Column 3 + Column 4 for lines 1-7, 9-12, 14-24, 52-59, and 61-93. o Line 1 for columns 1-4 must be equal to line 19 of the previous month. o Line 1 Column 5 must be equal to line 30 of the previous month. o Line 1 Column 6 must be equal to line 40 of the previous month. o Line 1 + line 2 = line 3. o Line 3 + line 4 - line 5 - line 6 = line 19 for columns 1-4. o Line 3 + line 4 - line 5 - line 6 for column 5 = line 30. o Line 3 + line 4 - line 5 - line 6 for column 6 = line 40. o Line 4A must be less than or equal to line 4. o Line 6 = line 9 + line 10 + line 11. o Line 6 = line 14 + line 15 + line 16 + line 17 + line 18 for column 1-4. o Line 6, column 5 = line 26 + line 27 + line 28 + line 29. o Line 6, column 6 = line 36 + line 37 + line 38 + line 39. o Line 7 must be greater than or equal to line 6. o Line 9 + line 11 for column 6 must be less than or equal to the sum of columns 1, 2, and 3 for line 47. o Line 19 = line 20 + line 21 + line 22 + line 23 + line 24. o Line 30 = line 31 + line 32 + line 33 + line 34. o Line 40 = line 41 + line 42 + line 43 + line 44. o Line 47 = line 45 + line 46 for columns 1-3. o Line 47 = line 49 + line 50 + line 51 for columns 2 and 3 only. o Line 48 must be less than or equal to line 47 for columns 1, 2, and 3. o Line 49 (column 4) must be less than or equal to line 49 (column 2) + line 49 (column 3). o Line 50 (column 4) must be less than or equal to the sum of line 50 (column 2) + line 50 (column 3). o Line 51 (column 4) must be less than or equal to the sum of line 51 (column 2) + line 51 (column 3). o Line 52 must be equal to line 67 of the previous month. o Line 54 = line 52 + line 53. o Line 54 + line 55 - line 61 = line 67. o Line 57 must be greater than or equal to line 56. o Line 58 must be less than or equal to line 56. o Line 59 must be less than or equal to line 56. o Line 59 must be greater than or equal to line 58. o Line 61 = line 63 + line 64 + line 65. o Line 62 must be greater than or equal to 500 times the sum of lines 63 and 65 in Column (5) only (each case must involve at least $500 per case). o Line 66 must be greater than or equal to line 65 (must award at least $1 per case). o Line 68 = line 69 + line 70 + line 71. o Line 72 = line 73 + line 74 + line 75 + line 76. o Line 78 = must be greater than or equal to line 77 (at least $1 per claim). o Line 79 = line 80 + line 81 + line 82. o Line 83, must be greater than or equal to line 82 (at least $1 per claim). o Line 84 = line 85 + line 86 + line 87. o Line 88 must be greater than or equal to line 87 (at least $1 per claim). o Line 89 = line 90 + line 91 + line 92. o Line 93 must be greater than or equal to line 92 (at least $1 per claim). Public reporting burden for this collection of information is estimated to average 2 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to Office of Financial Management, CMS, P.O. Box 26684, Baltimore, MD 21207; and to the Office of Management and Budget, Paperwork Reduction Project Washington, DC 20503.