,,3895 (Cont.),,, FORM CMS-1984-99,,,,,,08-06 ,,,ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,, TABLE 2 - WORKSHEET INDICATORS,,,,,,, ,,,,,,,,,,, ,,This table contains the worksheet indicators that are used for electronic cost reporting.,,,,,,,,, ,,A worksheet indicator is provided only for those worksheets from which data are to be provided.,,,,,,,,, ,,,,,,,,,,, ,,The worksheet indicator consists of seven characters in positions 2-8 of the record identifier. The,,,,,,,,, ,,first two characters of the worksheet indicator (positions 2 and 3 of the record identifier) always show,,,,,,,,, ,,the worksheet. The third character of the worksheet indicator (position 4 of the record identifier),,,,,,,,, ,,"is used in several ways. It may be used as part of the worksheet, e.g., A81. The fourth character",,,,,,,,, ,,"of the worksheet indicator (position 5 of the record identifier) represents the type of provider, by",,,,,,,,, ,,"using the keys below. Except for Worksheet A-6 (to handle multiple worksheets), the fifth and sixth",,,,,,,,, ,,characters of the worksheet indicator position 6 and 7 of the record identifier) identify worksheets,,,,,,,,, ,,"Federal program (18 = title XVIII, 05 = Title V, or 19 =Title XIX) or worksheets required for the ",,,,,,,,, ,,facility (00 = Universal). The seventh character of the worksheet indicator (position 8 of the record,,,,,,,,, ,,identifier) represent the worksheet part.,,,,,,,,, ,,,,,,,,,,, ,,,,Worksheets Which Apply to the Hospice Cost Report,,,,,,, ,,,,,,,,,,, ,,,,,,,,Worksheet,,, ,,,,Worksheet,,,,Indicator,,, ,,,,,,,,,,, ,,,,S-1 (a),,,,S100000,,, ,,,,A,,,,A000000,,, ,,,,A-1,,,,A100000,,, ,,,,A-2,,,,A200000,,, ,,,,A-3,,,,A300000,,, ,,,,A-6 (b),,,,A600010 ,,, ,,,,A-7,,,,A700000,,, ,,,,A-8,,,,A800000,,, ,,,,"A-8-1, Part A",,,,A81000A,,, ,,,,"A-8-1, Part B",,,,A81000B,,, ,,,,B-1 (For use in column headings),,,,B10000*,,, ,,,,B,,,,B000000,,, ,,,,B-1,,,,B100000,,, ,,,,D,,,,D000000,,, ,,,,G,,,,G000000,,, ,,,,G-1,,,,G100000,,, ,,,,"G-2, Part I",,,,G200001,,, ,,,,"G-2, Part II ",,,,G200002,,, ,,,,,,,,,,, ,, (a),Worksheets With Multiple Parts Using Identical Worksheet Indicator,,,,,,,, ,,,"Although this worksheet has several parts, the lines are numbered sequentially. This",,,,,,,, ,,,worksheet identifier is used with all lines from this worksheet regardless of the worksheet,,,,,,,, ,,,part. This differs from the Table 3 presentation which still identifies each worksheet and,,,,,,,, ,,,part as they appear on the printed cost report. This affects Worksheet S-1.,,,,,,,, ,,,,,,,,,,, ,, (b),Multiple Worksheets for Reclassification and Adjustments Before and After Stepdown,,,,,,,, ,,,The fifth and sixth digits of the worksheet indicator (positions 6 and 7 of the record) are,,,,,,,, ,,,numeric from 01-99 to accommodate reports with more lines on Worksheets A-6. For reports,,,,,,,, ,,,"which do not need additional worksheets, the default is 01. For reports which d need",,,,,,,, ,,,"additional worksheets, the first page of each worksheet is numbered .01. The number for",,,,,,,, ,,,each additional page of each worksheet is incremented by 1.,,,,,,,, ,,38-212,,,,,,,,,Rev. 7