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Form CMS-2552-10
Transmittal #5 Changes
Compu-Max 2552-10 Version 2014.03
Form CMS 2552-10 Transmittal #5 Changes
Contents
Timeline
Review of significant changes in Form CMS-2552-10 Transmittal #5
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independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
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of KPMG International. 30039BOS
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Timeline
February 28, 2014 – CMS distributed Transmittal #5 draft forms, instructions and
ECR specifications to the vendors for review and comment. Comments requested
by March 7.
Vendors responded with initial comments before March 7.
CMS issued a second test case on March 13, in response to vendor questions
and comments.
Vendors submitted test case ECR and PI files between March 18 and March 25.
CMS issued a third test case on March 26, in response to items that had been
brought up by the vendors in the process of completing the revisions in the March
13 version of the test case.
Vendors submitted final test case ECR and PI files on March 27 and provided
CMS with test copies of the T-5 software.
CMS published “final” T-5 forms, instructions and ECR specs on Friday, March 28.
Vendors approved for T-5 on Monday, March 31.
Compu-Max 2552-10 T-5 software put on website Tuesday, April 1.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
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Review of the Major Transmittal #5 Changes
NOTE: This document addresses the most significant changes in Form
CMS-2552-10 Transmittal #5. It should not be considered a substitute for
reviewing the actual instructions and forms as issued by CMS, accessible
via the Compu-Max software’s Help file.
Form CMS-2552-10 Transmittal #5 is effective for cost reporting
periods overlapping or beginning on or after October 1, 2013.
CMS changes to the forms and instructions are noted in red, italicized text.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
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Worksheet S-2 Part I Line 22.01 – Uncompensated Care Payments
The use of Worksheet E Part A, Lines 35, 35.01, 35.02, 35.03 and 36 is
determined by the responses on S-2 Part I, Line 22.01. In addition, S-2 Part I,
Line 22, Column 1 must contain a response of “Y”.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
5
Worksheet S-2 Part I Line 121 – High Cost Implantable Devices
Instructional change only. Related changes made to Worksheet A,
Lines 71 and 72.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
6
Worksheet S-3 Part I, Line 32
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
7
Worksheet A – Clarifications to Line 4 Instructions
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
8
Worksheet A, Revision of Line 71 Instructions
(Medical Supplies Charged to Patients)
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
9
Worksheet A, Revision of Line 72 Instructions
(Implantable Devices Charged to Patients)
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
10
Worksheet E Part A, Lines 1, 1.01, 1.02, 1.03, 2.02
Line 1 will be shaded for cost reporting periods overlapping 10/1/2013. Lines 1.01
and 1.02 will be shaded for cost reporting periods beginning on/after 10/1/2013.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
11
Worksheet E Part A, Lines 1, 1.01, 1.02, 1.03, 2.02 (continued)
Line 1 will be shaded for cost reporting periods overlapping 10/1/2013. Lines 1.01
and 1.02 will be shaded for cost reporting periods beginning on/after 10/1/2013.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
12
Worksheet E Part A, Lines 1, 1.01, 1.02, 1.03, 2.02 (continued)
These changes also impact the calculation of E Part A, Lines 22, 28, 34, 47, 62 and 63,
which have all been updated to refer to Lines 1.01, 1.02, 1.03 and 2.02 as necessary. Refer
to the CMS instructions for full details. Also, refer to the CMS instructions for Line 72
regarding the inclusion of payments associated with Model 4 BPCI with interim payments.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
13
Worksheet E Part A, Line 34
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
14
Worksheet E Part A, Lines 35, 35.01, 35.02, 35.03 and 36
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
15
Worksheet E Part A, Lines 35, 35.01, 35.02, 35.03 and 36 (continued)
The Factor 3 value for Line 35.01 will be filled in by the software IF the hospital’s
provider number is included in the CMS public use file that contains this information.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
16
Worksheet E Part A, Lines 35, 35.01, 35.02, 35.03 and 36 (continued)
The Uncompensated Care Payment for Line 35.02 will be filled in by the software IF the
hospital’s provider number is included in the CMS public use file that contains this data.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
17
Worksheet E Part A, Lines 35, 35.01, 35.02, 35.03 and 36 (continued)
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
18
Worksheet E Part B, Lines 39.98 and 40
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
19
Worksheet E-3 Part III, Line 1
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
20
Worksheet E-3 Part III, Line 3
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
21
Worksheet E-3 Part III, Lines 10-13
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
22
Worksheet E-3 Part III, Lines 10-13 (continued)
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
23
Worksheet E-3 Part III, Lines 10-13 (continued)
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
24
Worksheet E-4, Lines 26 and 27
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
25
Worksheet L Part I, Lines 1.01 and 2.01
These changes also impact the calculation of L Part I, Lines 6, 11 and 12. Refer to the
CMS instructions for full details.
© 2013 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity.
All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks
of KPMG International. 30039BOS
26