MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C6334E.55F282A0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C6334E.55F282A0 Content-Location: file:///C:/0CE7B2D4/2006RHCCostReportChecklist.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Cost Report Checklist

 

   &n= bsp; RHC Cost Report Workpaper Checklist (Please submit with workpapers)<= o:p>

Item Number

 

Description of What is nee= ded

√  if included

 

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1

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>We ne= ed at least one of the following items to determine the total expenses paid= by clinic during the year.  The reports should be for the entire accounting period which is typically 12 months.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

a.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Accou= nting trial balance of expenses for the cost report period.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

b.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Finan= cial statements from the accountants or QuickBooks expense statements for the cost report period.

 

c.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Feder= al Tax returns for the corporation, partnership, or 1040.

 

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

 

2

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>We ne= ed at least one of the following to determine the total patient visits or encounters and need one of the following.

 

a.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>CPT F= requency report by Provider from your computer system.

 

b.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Writt= en or manual visit count with physician, physician assistant, and nurse practit= ioner visits provided.

 

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

 

3

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>W-2&#= 8217;s with the employee’s position listed on the W-2 or what the employee= did during their employment. (Note: This is not applicable if your financials list salaries by physicians, Physician Assistant, Nurse Practitioner, Nur= ses, Office, radiology, and laboratory salaries.

 

 

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

 

4

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>We need all of the following information to claim Influenza and Pneumoccocal reimbursement on the cost report.

 

a.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Medic= are logs with patient name & HIC number and date of service for pneumoccocal a= nd influenza patients.

 

b.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>A cou= nt, listing, or log on non-Medicare patients in order for us to determine tot= al flu shots provided.

 

c.

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Invoi= ces supporting influenza and pneumoccocal purchases during the year.  This will help us to determine t= he cost of the supply cost.

 

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

 

5

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Medic= are P S & R report which will be mailed from Medicare and should be received = about four months after year-end.

 

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>=  

 

6

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>Medic= are Bad Debt Listing.  Complete all = 10 columns of Exhibit 5 and include a copy of the Medicaid remittance for Medicare/Caid Crossovers.  I= nclude an Excel Spreadsheet if you have one.

 

 

<= span lang=3DEN style=3D'font-size:8.0pt;font-family:"Book Antiqua";mso-ansi-la= nguage: EN'> 

 

7

<= span lang=3DEN style=3D'font-family:"Book Antiqua";mso-ansi-language:EN'>List = any related party transactions (RPT) which include any rental payments by the corporation to the physician/owner or the owner’s relatives.  Copy 1099s for our file if your = think you may have a RPT.

 

 

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Healthcare Business Specialists

Suite 214, 502 Shadow Parkway, Chattanooga, TN  37421=

www.ruralhealthclinic.com

Telephone: (800) 768-0278 Fax: (42= 3) 892-9437

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