SNFData - 115146 - 06/2000 - Worksheet S-7, Part III

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INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, 3514.3, REV 7

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MUSCOGEE MANOR & REHAB FACILITY
COLUMBUS, GA 31907

Medicare Provider Number: 115146

Cost report status: Settled Without Audit

[Record Code 115551 - 1996]

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PPS STATISTICAL DATA				PROVIDER NO: 115146		PERIOD: FROM 07/01/1999 TO 06/30/2000			WORKSHEET S-7 Part III
TRANSITION PERIOD: [ ] YEAR # 1 [ ### ] YEAR # 2 [ ] YEAR # 3 [ ] YEAR # 4 - 100% Federal Case Mix Rate
	HIPPS CODE GROUP	FACILITY SPECIFIC RATE	SERVICES PRIOR TO 10/01		SERVICES AFTER 9/30		SUBTOTAL		YR 1: Col. 9 = Col. 7 X 25% Col. 10 = Col. 8 X 75%
			FEDERAL CASE MIX RATE	DAYS	FEDERAL CASE MIX RATE	DAYS	FEDERAL CASE MIX (Col. 3 X 4, PLUS Col . 5 X 6)	FACILITY SPECIFIC (Col. 4 + 6 X Col. 2)	YR 1: Col. 9 = Col. 7 X 25% Col. 10 = Col. 8 X 75%
									YR 2: Col. 9 = Col. 7 X 50% Col. 10 = Col. 8 X 50%
									YR 2: Col. 9 = Col. 7 X 50% Col. 10 = Col. 8 X 50%
									YR 3: Col. 9 = Col. 7 X 75% Col. 10 = Col. 8 X 25%
									YR 3: Col. 9 = Col. 7 X 75% Col. 10 = Col. 8 X 25%
	1	2	3	4	5	6	7	8	9	10
1	RUC	###	###	###	###	###	###	###	###	###	1
2	RUB	###	###	###	###	###	###	###	###	###	2
3	RUA	###	###	###	###	###	###	###	###	###	3
4	RVC	###	###	###	###	###	###	###	###	###	4
5	RVB	###	###	###	###	###	###	###	###	###	5
6	RVA	###	###	###	###	###	###	###	###	###	6
7	RHC	###	###	###	###	###	###	###	###	###	7
8	RHB	###	###	###	###	###	###	###	###	###	8
9	RHA	###	###	###	###	###	###	###	###	###	9
10	RMC	###	###	###	###	###	###	###	###	###	10
11	RMB	###	###	###	###	###	###	###	###	###	11
12	RMA	###	###		###	###	###	###	###	###	12
13	RLB	###	###		###						13
14	RLA	###	###		###	###	###	###	###	###	14
15	SE3	###	###	###	###	###	###	###	###	###	15
16	SE2	###	###	###	###	###	###	###	###	###	16
17	SE1	###	###	###	###	###	###	###	###	###	17
18	SSC	###	###	###	###	###	###	###	###	###	18
19	SSB	###	###	###	###	###	###	###	###	###	19
20	SSA	###	###	###	###	###	###	###	###	###	20
21	CC2	###	###		###						21
22	CC1	###	###	###	###	###	###	###	###	###	22
23	CB2	###	###	###	###		###	###	###	###	23
24	CB1	###	###	###	###	###	###	###	###	###	24
25	CA2	###	###	###	###		###	###	###	###	25
26	CA1	###	###	###	###	###	###	###	###	###	26
27	IB2	###	###		###						27
28	IB1	###	###		###	###	###	###	###	###	28
29	IA2	###	###		###						29
30	IA1	###	###		###						30
31	BB2	###	###		###						31
32	BB1	###	###		###	###	###	###	###	###	32
33	BA2	###	###		###						33
34	BA1	###	###		###						34
35	PE2	###	###		###						35
36	PE1	###	###		###						36
37	PD2	###	###		###	###	###	###	###	###	37
38	PD1	###	###		###	###	###	###	###	###	38
39	PC2	###	###		###						39
40	PC1	###	###		###						40
41	PB2	###	###	###	###	###	###	###	###	###	41
42	PB1	###	###		###	###	###	###	###	###	42
43	PA2	###	###		###						43
44	PA1	###	###		###						44
45	Default Rate	###	###		###						45
46	TOTAL			###		###					46