Worksheet S-7, Part I
- Return to Cost Report Summary
- Form S701
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, 3514, REV 4
SUNRISE CARE & REHAB FOR LUFKIN
LUFKIN, TX 75901
LUFKIN, TX 75901
Medicare Provider Number: 455855
Cost report status: As Submitted
[Record Code 65335 - 1996]
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NHCMQ DEMONSTRATION AND PPS STATISTICAL DATA |
PROVIDER NO: 455855 |
PERIOD: FROM 01/01/1998 TO 12/31/1998 |
WORKSHEET S-7 Part I | |||||
PART I - NHCMQ DEMONSTRATION STATISTICAL DATA FOR COST REPORTING PERIODS BEGINNING PRIOR TO JULY 1, 1998 |
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GROUP | M3PI REVENUE CODE |
SERVICES PRIOR TO JANUARY 1ST (1) | SERVICES ON OR AFTER JANUARY 1ST (1) | TOTAL (See Instructions) |
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RATE | DAYS | RATE | DAYS | |||||
1 | 2 | 3 | 3.01 | 4 | 4.01 | 5 | ||
1 | RVC | 9044 | ### | ### | 1 | |||
2 | RVB | 9043 | ### | ### | 2 | |||
3 | RVA | 9042 | ### | ### | 3 | |||
4 | RHD | 9041 | ### | ### | 4 | |||
5 | RHC | 9040 | ### | ### | 5 | |||
6 | RHB | 9039 | ### | ### | 6 | |||
7 | RHA | 9038 | ### | ### | 7 | |||
8 | RMC | 9037 | ### | ### | 8 | |||
9 | RMB | 9036 | ### | ### | 9 | |||
10 | RMA | 9035 | ### | ### | 10 | |||
11 | RLB | 9034 | ### | ### | 11 | |||
12 | RLA | 9033 | ### | ### | 12 | |||
13 | SE3 | 9032 | 13 | |||||
14 | SE2 | 9031 | 14 | |||||
15 | SE1 | 9030 | ### | ### | 15 | |||
16 | SSC | 9029 | ### | ### | 16 | |||
17 | SSB | 9028 | 17 | |||||
18 | SSA | 9027 | 18 | |||||
19 | CD2 | 9026 | ### | ### | 19 | |||
20 | CD1 | 9025 | ### | ### | 20 | |||
21 | CC2 | 9024 | ### | ### | 21 | |||
22 | CC1 | 9023 | ### | ### | 22 | |||
23 | CB2 | 9022 | ### | ### | 23 | |||
24 | CB1 | 9021 | ### | ### | 24 | |||
25 | CA2 | 9020 | ### | ### | 25 | |||
26 | CA1 | 9019 | ### | ### | 26 | |||
27 | IB2 | 9018 | 27 | |||||
28 | IB1 | 9017 | 28 | |||||
29 | IA2 | 9016 | 29 | |||||
30 | IA1 | 9015 | 30 | |||||
31 | BB2 | 9014 | 31 | |||||
32 | BB1 | 9013 | 32 | |||||
33 | BA2 | 9012 | 33 | |||||
34 | BA1 | 9011 | 34 | |||||
35 | PE2 | 9010 | 35 | |||||
36 | PE1 | 9009 | 36 | |||||
37 | PD2 | 9008 | 37 | |||||
38 | PD1 | 9007 | 38 | |||||
39 | PC2 | 9006 | 39 | |||||
40 | PC1 | 9005 | 40 | |||||
41 | PB2 | 9004 | 41 | |||||
42 | PB1 | 9003 | 42 | |||||
43 | PA2 | 9002 | 43 | |||||
44 | PA1 | 9001 | 44 | |||||
45 | Other Group | 9000 | 45 | |||||
46 | TOTAL | 46 | ||||||
(1) Calendar Year Providers: Complete columns 1, 2, 4, 4.01, and 5 | ||||||||
Fiscal Year Providers - Rate change as of January 1st: Complete ALL columns. | ||||||||
Fiscal Year Providers - Rate DOES NOT change as of January 1st: Complete columns 1, 2, 3, 3.01, and 5. |