,,03-04,,,,,FORM CMS-1984-99,,,,,,3895 (Cont.) ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,Table 1 specifies the standard record format to be used for electronic reporting. Each electronic,,,,,,,,,,, ,,cost report submission (file ) has four types of records. The first group (type 1 records) contains,,,,,,,,,,, ,,"information for identifying, processing, and resolving problems. The text used throughout the",,,,,,,,,,, ,,"cost report for variable line labels (e.g., Worksheet A) and variable column headers (Worksheet B-1)",,,,,,,,,,, ,,"are included in the type 2 records. Refer to Table 5 for cost center coding. The data, detailed",,,,,,,,,,, ,,"in Table 3, is identified as type 3 records. The encryption coding at the end of the file,",,,,,,,,,,, ,,"records 1, 1.01, and 1.02, are type 4 records.",,,,,,,,,,, ,,,,,,,,,,,,, ,,"The medium for transferring cost reports submitted electronically to fiscal intermediaries is 3½"" diskettes.",,,,,,,,,,, ,,These disks must be in IBM format. The character set must be ASCII. Providers should seek ,,,,,,,,,,, ,,approval from their fiscal intermediaries regarding the method of submission to insure that the method of,,,,,,,,,,, ,,transmission is acceptable.,,,,,,,,,,, ,,,,,,,,,,,,, ,,The following are requirements for all records:,,,,,,,,,,, ,,,,,,,,,,,,, ,,,1. All alpha characters must be in upper case.,,,,,,,,,, ,,,,,,,,,,,,, ,,,"2. For micro systems, the end of record indicator must be a carriage return and line feed, in that ",,,,,,,,,, ,,, sequence.,,,,,,,,,, ,,,,,,,,,,,,, ,,,3. No record may exceed 60 characters.,,,,,,,,,, ,,,,,,,,,,,,, ,,Below is an example of a set of type 1 records with a narrative description of their meaning.,,,,,,,,,,, ,,,,,,,,,,,,, ,, 1 2 3 4 5 6,,,,,,,,,,, ,,123456789012345678901234567890123456789012345678901234567890,,,,,,,,,,, ,,1 1 010123200400120043665A99P00520050202004366,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,Record #1:,,This is a cost report file submitted by Provider 010123 for the period from,,,,,,,,, ,,,,"January 1, 2004 (2004001) through Decmber 31, 2004 (2004366). It is filed on the Form",,,,,,,,, ,,,,"CMS-1984-99. It is prepared with vendor number A99's PC based system, version",,,,,,,,, ,,,,number 5. Position 38 changes with each new test case and/or reapproval and is alpha.,,,,,,,,, ,,,,Positions 39 and 40 will remain constant for approvals issued after the first test case.,,,,,,,,, ,,,,"This file is prepared by the hospice on January 20, 2005 (2005020). The electronic cost",,,,,,,,, ,,,,"report specification, dated December 31, 2004 (2004366), is used to prepare this file.",,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,Rev. 5,,,,,,,,,,,38-203 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,,03-04 ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,,,,,,FILE NAMING CONVENTION,,,,,, ,,,,,,,,,,,,, ,,Name each cost report file in the following manner:,,,,,,,,,,, ,,,"HSNNNNNN.YYL, where",,,,,,,,,, ,,,1. HS (Electronic Cost Report) is constant;,,,,,,,,,, ,,,2. NNNNNN is the 6 digit Medicare hospice provider number;,,,,,,,,,, ,,,3. YY is the year in which the provider's cost reporting period ends; and,,,,,,,,,, ,,,4. L is a character variable (A-Z) to enable separate identification of files from,,,,,,,,,, ,,, hospices with two or more cost reporting periods ending in the same calendar year.,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,RECORD NAME: Type 1 Records - Record Number 1,,,,,,, ,,,,,,,,,,,,, ,,,,,,Size,Usage,Loc.,,,Remarks,, ,,,,,,,,,,,,, ,,1.,Record Type,,,1,X,1,,"Constant ""1""",,, ,,,,,,,,,,,,, ,,2.,NPI ,,,10,9,2-11,,Numeric only,,, ,,,,,,,,,,,,, ,,3.,Space,,,1,X,12,,,,, ,,,,,,,,,,,,, ,,4.,Record Number,,,1,X,13,,"Constant ""1""",,, ,,,,,,,,,,,,, ,,5.,Spaces,,,3,X,14-16,,,,, ,,,,,,,,,,,,, ,,6.,Hospice Provider,,,6,9,17-22,,Field must have 6 numeric characters,,, ,,, Number,,,,,,,,,, ,,,,,,,,,,,,, ,,7.,Fiscal Year,,,,,,,YYYYDDD - Julian date; first day,,, ,, Ending Date, Beginning Date,,,7,9,23-29,,covered by this cost report,,, ,,,,,,,,,,,,, ,,8.,Fiscal Year,,,,,,,YYYYDDD - Julian date; last day ,,, ,,, Ending Date,,,7,9,30-36,,covered by this cost report,,, ,,,,,,,,,,,,, ,, 9.,MCR Version,,,1,9,37,,"Constant ""5"" (for Form ",,, ,,,,,,,,,,CMS 1984-99),,, ,,,,,,,,,,,,, ,, 10.,Vendor Code,,,3,X,38-40,,To be supplied upon approval. Refer,,, ,,,,,,,,,,to page 38-703.,,, ,,,,,,,,,,,,, ,,11.,Vendor Equipment,,,1,X,41,,P = PC; M = Main Frame,,, ,,,,,,,,,,,,, ,,12.,Version Number,,,3,X,42-44,,"Version of extract software, e.g.,",,, ,,,,,,,,,,"001=1st , 002=2nd, etc. or 101=1st,",,, ,,,,,,,,,,102=2nd. The version number must,,, ,,,,,,,,,,be incremented by 1 with each ,,, ,,,,,,,,,,recompile and release to client(s).,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,38-204,,,,,,,,,,,Rev. 5 ,,06-11,,,,,FORM CMS-1984-99,,,,,,3895 (Cont.) ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,,,,,RECORD NAME: Type 1 Records - Record Number 1 (Continued),,,,,,, ,,,,,,,,,,,,, ,,,,,,Size,Usage,Loc.,,,Remarks,, ,,,,,,,,,,,,, ,,13.,Creation Date,,,7,9,45-51,,YYYYDDD - Julian date; date on which,,, ,,,,,,,,,,the file was created (extracted from,,, ,,,,,,,,,,the cost report),,, ,,,,,,,,,,,,, ,,14.,ECR Spec. Date,,,7,9,52-58,,YYYYDDD - Julian date; date of,,, ,,,,,,,,,,electronic cost report specifications,,, ,,,,,,,,,,used in producing each file. Valid,,, ,,,,,,,,,,for cost reporting periods ending on,,, ,,,,,,,,,,or after 2011212 (7/31/2011). Prior,,, ,,,,,,,,,,"approvals 2006181, 2004366.",,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,RECORD NAME: Type 1 Records - Record Numbers 2 - 99,,,,,,, ,,,,,,,,,,,,, ,,,,,,Size,Usage,Loc.,,,Remarks,, ,,,,,,,,,,,,, ,,1.,Record Type,,,1,9,1,,"Constant ""1""",,, ,,,,,,,,,,,,, ,,2.,Spaces,,,10,X,2-11,,,,, ,,,,,,,,,,,,, ,,3.,Record Number,,,2,9,12-13,,#2 - Reserved for future use.,,, ,,,,,,,,,,,,, ,,,,,,,,,,#3 - Vendor information; optional,,, ,,,,,,,,,,record for use by vendors. Left,,, ,,,,,,,,,,justified in positions 21-60.,,, ,,,,,,,,,,,,, ,,,,,,,,,,#4 - The time that the cost report is,,, ,,,,,,,,,,created. This is represented in,,, ,,,,,,,,,,military time as alpha numeric. Use,,, ,,,,,,,,,,position 21-26. Example 2:30PM,,, ,,,,,,,,,,is expressed as 14:30.,,, ,,,,,,,,,,,,, ,,,,,,,,,,#5 to #99 - Reserved for future use.,,, ,,,,,,,,,,,,, ,,4.,Spaces,,,7,X,14-20,,Spaces (Optional),,, ,,,,,,,,,,,,, ,,5.,ID Information,,,40,X,21-60,,Left justified to position 21.,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,Rev. 8,,,,,,,,,,,38-205 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,,06-11 ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,,,,,RECORD NAME: Type 2 Records for Labels,,,,,,, ,,,,,,,,,,,,, ,,,,,,Size,Usage,Loc.,,,Remarks,, ,,,,,,,,,,,,, ,,1.,Record Type,,,1,9,1,,"Constant ""2""",,, ,,,,,,,,,,,,, ,,2.,Worksheet Indicator,,,7,X,2-8,,Alphanumeric. Refer to Table 2.,,, ,,,,,,,,,,,,, ,,3.,Spaces,,,2,X,9-10,,,,, ,,,,,,,,,,,,, ,,4.,Line Number,,,3,9,11-13,,Numeric,,, ,,,,,,,,,,,,, ,,5.,Subline Number,,,2,9,14-15,,Numeric,,, ,,,,,,,,,,,,, ,,6.,Column Number,,,3,X,16-18,,Alphanumeric,,, ,,,,,,,,,,,,, ,,7.,Subcolumn Number,,,2,9,19-20,,Numeric,,, ,,,,,,,,,,,,, ,,8.,Cost Center Code,,,4,9,21-24,,Numeric. Refer to Table 5 for,,, ,,,,,,,,,,appropriate cost center codes.,,, ,,,,,,,,,,,,, ,,9.,Labels/Headings,,,,,,,,,, ,,, a. Line Labels ,,,36, X,25-60,,"Alphanumeric, left justified",,, ,,,,,,,,,,,,, ,,, b. Column Headings,,,,,,,,,, ,,, Statistical,,,,,,,,,, ,, b. Col. Headings, Basis & Code,,,10, X,21-30,,"Alphanumeric, left justified",,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,"The type 2 records contain text which appears on the pre-printed cost report. Of these, there are",,,,,,,,,,, ,,three groups: (1) Worksheet A cost center names (labels); (2) column headings for stepdown entries;,,,,,,,,,,, ,,and (3) other text appearing in various places throughout the cost report. The standard cost center,,,,,,,,,,, ,,labels are listed below.,,,,,,,,,,, ,,,,,,,,,,,,, ,,A Worksheet A cost center label must be furnished for every cost center with cost or charge data,,,,,,,,,,, ,,anywhere in the cost report. The line and subline numbers for each label must be the same as the,,,,,,,,,,, ,,line and subline numbers of the corresponding cost center on Worksheet A. The columns and,,,,,,,,,,, ,,subcolumn numbers are always set to zero.,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,38-206,,,,,,,,,,,Rev. 8 ,,09-11,,,,,FORM CMS-1984-99,,,,,,3895 (Cont.) ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,,,,,RECORD NAME: Type 2 Records for Labels (Continued),,,,,,, ,,,,,,,,,,,,, ,,"Column headings for the General Service cost centers on Worksheets B-1and B are supplied once,",,,,,,,,,,, ,,consisting of one to three records. The statistical basis shown on worksheet B-1 is also reported.,,,,,,,,,,, ,,The statistical basis consists of one or two records (lines 4 and 5). Statistical basis code is supplied ,,,,,,,,,,, ,,"only to Worksheet B-1 columns and recorded as line 6 and only for capital cost centers, columns 1-4",,,,,,,,,,, ,,and subscripts as applicable. The statistical code agree with the statistical basis indicated on line 4,,,,,,,,,,, ,,"and 5, i.e., code 1 = square footage, code 2 = dollar value, and code 3 = all others. Refer to Table 2",,,,,,,,,,, ,,for the special worksheet identifier to be used with column headings and statistical basis and to,,,,,,,,,,, ,,Table 3 for line and column references.,,,,,,,,,,, ,,,,,,,,,,,,, ,,Use the following type 2 cost center descriptions for all Worksheet A standard cost center lines.,,,,,,,,,,, ,,,,,,,,,,,,, ,,Line,Description,,,,,Line,Description,,,, ,,1,CAPITAL REL COSTS-BLDG & FIXT,,,,,24,HOME HEALTH AIDE AND HOMEMAKER,,,, ,,2,CAPITAL REL COSTS-MOVABLE EQUIP,,,,,24.20,HH AIDE & HOMEMAKER-CONTINUOUS HOME CARE,,,, ,,3,PLANT OPERATION AND MAINTENANCE,,,,,25,OTHER VISITING SERVICES,,,, ,,4,TRANSPORTATION-STAFF,,,,,30,"DRUGS, BIOLOGICAL AND INFUSION",,,, ,,5,VOLUNTEER SERVICE COORDINATION,,,,,30.30,ANALGESICS,,,, ,,6,ADMINISTRATIVE AND GENERAL,,,,,30.31,SEDATIVES/HYPNOTICS,,,, ,,10,INPATIENT-GENERAL CARE,,,,,31,DURABLE MEDICAL EQUIPMENT/OXYGEN,,,, ,,11,INPATIENT-RESPITE CARE,,,,,32,PATIENT TRANSPORTATION,,,, ,,15,PHYSICIAN SERVICES,,,,,33,IMAGING SERVICES,,,, ,,16,NURSING CARE,,,,,34,LABS AND DIAGNOSTICS,,,, ,,16.20,NURSING CARE-CONTINUOUS HOME CARE,,,,,35,MED SUPPLIES CHARGED TO PATIENTS ,,,, ,,17,PHYSICAL THERAPY,,,,,36,OUTPATIENT SERVICES (INCL E/R DEPT.),,,, ,,18,OCCUPATIONAL THERAPY,,,,,37,RADIATION THERAPY,,,, ,,19,SPEECH/LANGUAGE PATHOLOGY,,,,,38,CHEMOTHERAPY,,,, ,,20,MEDICAL SOCIAL SERVICES,,,,,39,OTHER HOSPICE SERVICE COST CENTER,,,, ,,21,SPIRITUAL COUNSELING,,,,,50,BEREAVEMENT PROGRAM COSTS,,,, ,,22,DIETARY COUNSELING,,,,,51,VOLUNTEER PROGRAM COSTS,,,, ,,23,COUNSELING-OTHER,,,,,52,FUNDRAISING,,,, ,,,,,,,,53,OTHER NONREIMBURSABLE COSTS,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,"Type 2 records for Worksheet B-1, columns 1-6, lines 1-2 and line 6 (for columns 1-4",,,,,,,,,,, ,,only (capital cost center columns)) are listed below. The numbers running vertical to line 1 ,,,,,,,,,,, ,,descriptions are the general service cost center line designations.,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,, LINE,,,,,, ,,,1,,2,,3,,4,,5,,6 ,,1,CAPITAL,,BLDGS &,,FIXTURES,,SQUARE,,FEET,,1 ,,2,CAPITAL,,MOVABLE,,EQUIPMENT,,DOLLAR,,VALUE,,2 ,,3,PLANT,,OPER. &,,MAINT.,,SQUARE,,FEET,,1 ,,4,TRANS-,,PORTAT-,,ION,,MILEAGE,,,,3 ,,5,VOLUNT.,,SERVICES,,COORDI.,,HOURS OF,,SERVICE,,3 ,,6,ADMINIS-,,TRATIVE &,,GENERAL,,ACCUM.,,COSTS,,3 ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,Rev. 9,,,,,,,,,,,38-207 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,,09-11 ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,,, ,,,,,,,,,,,,, ,,"Examples of type 2 records are below. Either zeros or spaces may be used in the line, subline,",,,,,,,,,,, ,,"column, and subcolumn number fields (positions 11-20). Spaces are preferred. (See",,,,,,,,,,, ,,first two lines of the example.)* Refer to Table 6 for additional cost center code requirements.,,,,,,,,,,, ,,,,,,,,,,,,, ,,Examples:,,,,,,,,,,, ,,,,,,,,,,,,, ,,,Worksheet A line labels with embedded cost center codes:,,,,,,,,,, ,,,,,,,,,,,,, ,,*,2A000000 1 0100CAP REL COSTS-BLDS & FIXT,, 0100CAPITAL REL COSTS-BLDG & FIXT,,,,,,,, ,,*,2A000000 101 0101CAPITAL REL COSTS-WEST WING,,,,,,,,,, ,,,2A000000 2 0200CAP REL COSTS-MVBLE EQUIP,, 0200CAPITAL REL COSTS-MOVABLE EQUIP,,,,,,,, ,,,2A000000 6 0600ADMINISTRATIVE AND GENERAL,,,,,,,,,, ,,,2A000000 10 1000INPATIENT-GENERAL CARE,,,,,,,,,, ,,,2A000000 11 1100INPATIEN-RESPITE CARE,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,"Examples of column headings for Worksheets B-1 and B, statistical bases used in cost",,,,,,,,,, ,,,"allocation on Worksheet B-1, and statistical coded used for worksheet B-1 (line 6)",,,,,,,,,, ,,,are displayed below. ,,,,,,,,,, ,,,,,,,,,,,,, ,,,2B10000* 1 1 CAP,,,,,,,,,, ,,,2B10000* 2 1 BLDGS &,,,,,,,,,, ,,,2B10000* 3 1 FIXTURES,,,,,,,,,, ,,,2B10000* 4 1 SQUARE,,,,,,,,,, ,,,2B10000* 5 1 FEET,,,,,,,,,, ,,,2B10000* 6 1 1,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,38-208,,,,,,,,,,,Rev. 9 ,,03-04,,,,,FORM CMS-1984-99,,,,,,3895 (Cont.) ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,,,,,RECORD NAME: Type 3 Records for Nonlabel Data,,,,,,, ,,,,,,,,,,,,, ,,,,,,Size,Usage,Loc.,,,Remarks,, ,,,,,,,,,,,,, ,,1.,Record Type,,,1,9,1,,"Constant ""3""",,, ,,,,,,,,,,,,, ,,2.,Worksheet Indicator,,,7,X,2-8,,Numeric. Refer to Table 2.,,, ,,,,,,,,,,,,, ,,3.,Spaces,,,2,X,9-10,,,,, ,,,,,,,,,,,,, ,,4.,Line Number,,,3,9,11-13,,Numeric,,, ,,,,,,,,,,,,, ,,5.,Subline Number,,,2,9,14-15,,Numeric,,, ,,,,,,,,,,,,, ,,6.,Column Number,,,3,X,16-18,,Alphanumeric,,, ,,,,,,,,,,,,, ,,7.,Subcolumn Number,,,2,9,19-20,,Numeric,,, ,,,,,,,,,,,,, ,,8.,Field Data,,,,,,,,,, ,,, a. Alpha Data,,,36,X,21-56,,Left justified. (Y or N for yes/no,,, ,,,,,,,,,,answers; dates must use mm/dd/yyyy,,, ,,,,,,,,,,"format - slashes, no hyphens).",,, ,,,,,,,,,,Refer to Table 6 for additional,,, ,,,,,,,,,,requirements for alpha data.,,, ,,,,,,,,,,,,, ,,,,,,4,X,57-60,,Spaces (optional).,,, ,,,,,,,,,,,,, ,,, b. Numeric Data,,,16,9,21-36,,Right justified. May contain ,,, ,,,,,,,,,,embedded decimal point. Leading,,, ,,,,,,,,,,zeros are suppressed; trailing zeros,,, ,,,,,,,,,,to the right of the decimal point,,, ,,,,,,,,,,are not. (See example below.),,, ,,,,,,,,,,"Positive values are presumed; no ""+""",,, ,,,,,,,,,,signs are allowed. Use leading ,,, ,,,,,,,,,,"minus to specify negative values,",,, ,,,,,,,,,,unless the field is defined as negative,,, ,,,,,,,,,,on the form. Express percentages,,, ,,,,,,,,,,"as decimal equivalents, i.e., 8.75% is",,, ,,,,,,,,,,expressed as .087500. All records,,, ,,,,,,,,,,with zero values are dropped. ,,, ,,,,,,,,,,Refer to Table 6 for additional,,, ,,,,,,,,,,requirements regarding numeric data.,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,Rev. 5,,,,,,,,,,,38-209 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,,03-04 ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,A sample of type 3 records and a number line for reference are below.,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,1 1,3,,,,,,, ,,,123456789,,5 8,6,,,,,,, ,,,,,,,,,,,,, ,,,3A000000 ,4, 1,32961,,,,,,, ,,,3A000000 ,21, 1,1336393,,,,,,, ,,,3A000000,21,1 1,185599,,,,,,, ,,,3A000000,52,1 1,17750,,,,,,, ,,,3A000000,1, 2,1014775,,,,,,, ,,,3A000000,1,1 2,1767922,,,,,,, ,,,3A000000,2, 2,14596,,,,,,, ,,,3A000000,21, 2,768441,,,,,,, ,,,3A000000,21,1 2,2746235,,,,,,, ,,,3A000000,52,1 2,4982,,,,,,, ,,,,,,,,,,,,, ,,"The line numbers are numeric. In several places throughout the cost report (see list below), the line",,,,,,,,,,, ,,numbers themselves are data. The placement of the line and subline numbers as data must be uniform.,,,,,,,,,,, ,,,,,,,,,,,,, ,,,"Worksheet A-6, columns 3, and 7",,,,,,,,,, ,,,"Worksheet A-8, column 4",,,,,,,,,, ,,,"Worksheet A-8-1, Part A, column 1",,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,38-210,,,,,,,,,,,Rev. 5 ,,08-06,,,,,FORM CMS-1984-99,,,,,,3895 (Cont.) ,,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,,, ,,,,,, TABLE 1 - RECORD SPECIFICATIONS,,,,,,, ,,,,,,,,,,,,, ,,Examples of records (*) with a Worksheet A line number as data and a number line,,,,,,,,,,, ,,for reference are below.,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,1,1,,2,,,,,, ,,,123456789,3,8,,1,,,,,, ,,,,,,,,,,,,, ,,,3A600010,13,0,,TO SPREAD INTEREST EXPENSE,,,,,, ,,,3A600010,13,1,,G,,,,,, ,,*,3A600010,13,3,,,,1.00,,,, ,,,3A600010,13,4,,,,221409,,,, ,,*,3A600010,13,7,,,,52.00,,,, ,,,3A600010,13,8,,,,225321,,,, ,,,3A600010,14,0,,BETWEEN CAPITAL-RELATED COST ,,,,,, ,,,3A600010,14,1,,G,,,,,, ,,*,3A600010,14,3,,,,4.01,,,, ,,,3A600010,14,4,,,,3912,,,, ,,,3A600010,15,0,,BUILDING & FIXTURES AND,,,,,, ,,,3A600010,16,0,,ADMINISTRATIVE AND GENERAL,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,"RECORD NAME: TYPE ""3"" RECORDS",,,,,,,, ,,,,,,,,,,,,, ,,,,1,1,,2,,,,,, ,,,123456789,3,8,,1,,,,,, ,,,,,,,,,,,,, ,,,3A800000,8,1 1,,MISCELANEOUS ADJUSTMENT,,,,,, ,,,3A800000,8,1 2,,A,,,,,, ,,,3A800000,8,1 3,,,,-250935,,,, ,,*,3A800000,8,1 4,,,,61.00,,,, ,,,3A810000,1, 3,,CAT SCANS,,,,,, ,,,3A810000,1, 4,,,,13352,,,, ,,,3A810000,1, 5,,,,11122,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,RECORD NAME: TYPE 4 RECORDS - File Encryption ,,,,,,,, ,,,,,,,,,,,,, ,,,"This type 4 record consist of 3 records: 1, 1.01, and 1.02. These records are",,,,,,,,,, ,,,created at the point in which the ECR file has been completed and saved to disk or ,,,,,,,,,, ,,,compact disk to insure the integrity of the file. ,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,Rev. 7,,,,,,,,,,,38-211