Worksheet S-7, Part I
- Return to Cost Report Summary
- Form S701
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, 3514, REV 4
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BROOKLYN, NY 11235
BROOKLYN, NY 11235
Medicare Provider Number: 335288
Cost report status: Settled Without Audit
[Record Code 125194 - 1996]
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NHCMQ DEMONSTRATION AND PPS STATISTICAL DATA |
PROVIDER NO: 335288 |
PERIOD: FROM 01/01/2001 TO 12/31/2001 |
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. |