,,08-06,,,,,FORM CMS-1984-99,,,,,3895 (Cont.) ,,,, ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,,,,, TABLE 6 - EDITS,,,,, ,,,,,,,,,,,, ,,Medicare cost reports submitted electronically must meet a variety of edits. These include mathematical,,,,,,,,,, ,,"accuracy edits, certain minimum file requirements, and other data edits. Any vendor software which",,,,,,,,,, ,,produces an electronic cost report file for Medicare hospices must automate all of these edits. Failure,,,,,,,,,, ,,to properly implement these edits may result in the suspension of a vendor's system certification until,,,,,,,,,, ,,corrective action is taken. The vendor's software should provide meaningful error messages to notify the,,,,,,,,,, ,,hospice of the cause of every exception. The edit message generated by the vendor systems must contain,,,,,,,,,, ,,"the related 4 digit and 1 alpha character, where indicated, reject/edit code specified below. Any file",,,,,,,,,, ,,submitted by a provider containing a level I edit will be rejected by the fiscal intermediary. Notification,,,,,,,,,, ,,must be made to CMS for any exceptions.,,,,,,,,,, ,,,,,,,,,,,, ,,The edits are applied at two levels. Level I edits (1000 series reject codes) are those which test the,,,,,,,,,, ,,format of the data to identify for correction of those error conditions which will result in a cost report,,,,,,,,,, ,,rejection. These edits also test for the presence of some critical data elements specified in Table 3.,,,,,,,,,, ,,Level II edits (2000 series edit codes) identify potential inconsistencies and/or missing data items.,,,,,,,,,, ,,These items should be resolved at the provider site and appropriate worksheets and/or data submitted,,,,,,,,,, ,,with the cost report. Failure to submit the appropriate data with your cost report may result in,,,,,,,,,, ,,payments being withheld pending resolution of the issue(s).,,,,,,,,,, ,,,,,,,,,,,, ,,The vendor requirements (above) and the edits (below) reduce both intermediary (FI) processing time ,,,,,,,,,, ,,and unnecessary rejections. Vendors should develop their programs to prevent their client hospices ,,,,,,,,,, ,,from generating an electronic cost report file where Level I edits conditions exist. Ample warnings,,,,,,,,,, ,,should be given the provider where Level II edit conditions are violated.,,,,,,,,,, ,,,,,,,,,,,, ,,Note: Dates in brackets [ ] at end of edit indicate effective date of that edit for cost reporting periods,,,,,,,,,, ,,,"ending on or after that date. Dates followed by a ""b"" are for cost reporting periods beginning",,,,,,,,, ,,,"on or after and the date followed by an ""s"" are for services rendered on or after the specified",,,,,,,,, ,,,date. [12/31/2004],,,,,,,,, ,,,,,,,,,,,, ,,I. Level I Edits (Minimum File Requirements),,,,,,,,,, ,,,,,,,,,,,, ,,Edit,,,Condition,,,,,,, ,,,,,,,,,,,, ,,1000,,"The first digit of every record must be either 1, 2, 3, or 4 (encryption code only). [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1005,,No record may exceed 60 characters. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1010,,"All alpha characters must be in upper case. This is exclusive of the vendor information,",,,,,,,, ,,,,"type 1 record, record number 3 and the encryption code, type 4 record, record numbers",,,,,,,, ,,,,"1, 1.01, and 1.02. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1015,,"For micro systems, the end of record indicator must be a carriage return and line feed, in",,,,,,,, ,,,,that sequence. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1020,,"The hospice provider number (record #1, positions 17-22) must be valid and numeric. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1025,,"All dates (record #1, positions 23-29, 30-36, 45-51, and 52-58) must be in Julian format and",,,,,,,, ,,,,a possible date. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,Rev. 7,,,,,,,,,,38-223 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,08-06 ,,,, ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,,,,, TABLE 6 - EDITS,,,,, ,,,,,,,,,,,, ,,Edit,,,Condition,,,,,,, ,,,,,,,,,,,, ,,1030,,"The fiscal year beginning date (record #1, positions 23-29) must be greater than 28 days and the ",,,,,,,, ,,,,"fiscal year ending date (record #1, positions 30-36) cannot exceed 457 days. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1035,,"The vendor code (record #1, positions 38-40) must be a valid code. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1050,,The type 1 record #1 must be correct and the first record in the file. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1055,,All record identifiers (positions 1-20) must be unique. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,,,NOTE: FIs attempt to correct if all record identifiers are not unique in their working copy and,,,,,,,, ,,,,," continue processing the cost report. If the condition is correctable, they notify",,,,,,, ,,,,, the provider's vendor and send copy of ECR file both to the vendor and CMS,,,,,,, ,,,,, Central Office. CMS Central Office requires a vendor software update to,,,,,,, ,,,,, resolve condition. [12/31/2004],,,,,,, ,,,,,,,,,,,, ,,1060,,Only a Y or N are valid for fields which require a yes/no response. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1065,,"Variable columns (Worksheet B, and Worksheet B-1) must have a corresponding type 2",,,,,,,, ,,,,record (Worksheet A label) with a matching line number. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1070,,"All line, subline, column, and subcolumn numbers (positions 11-13, 14-15, 16-18, and 19-20, ",,,,,,,, ,,,,"respectively) must be numeric, except for any cost center with accumulated cost as its ",,,,,,,, ,,,,statistics which must have its Worksheet B-1 reconciliation column numbered the same as its ,,,,,,,, ,,,,"Worksheet A line number followed by an ""A"" as part of the line number followed by the subline",,,,,,,, ,,,,number. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1075,,"Cost center integrity must be maintained throughout the cost report. For subscripted lines,",,,,,,,, ,,,,the relative position must be consistent throughout the cost report. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1080,,"For every line used on Worksheets A, A-1, A-2, A-3 and B, there must be a corresponding ",,,,,,,, ,,,,type 2 record. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1090,,"Fields requiring numeric data (days, charges, discharges, costs, etc.) may not contain any alpha",,,,,,,, ,,,,character. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1100,,"In all cases where the file includes both a total and the parts which comprise that total,",,,,,,,, ,,,,each total must equal the sum of its parts. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1005S,,"The cost report ending date must be on or after December 31, 2004. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1010S,,The hospice name must be present on worksheet S-1 line 1 column 1. [12/31/2004},,,,,,,, ,,,,,,,,,,,, ,,1020S,,"The hospice name, address, county, certification date, and provider number (Worksheet S-1,",,,,,,,, ,,,,"lines 1, 2, 4 and 6, columns 1-5 as appropriate) must be present and valid. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1030S,,"All amounts reported on Worksheet S-1, must not be less than zero. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,38-224,,,,,,,,,,Rev. 7 ,,09-11,,,,,FORM CMS-1984-99,,,,,3895 (Cont.) ,,,, ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,,,,, TABLE 6 - EDITS,,,,, ,,,,,,,,,,,, ,,Edit,,,Condition,,,,,,, ,,,,,,,,,,,, ,,1040S,,"The hospice certification date (Worksheet S-1 line 4, column 1) must be present and ",,,,,,,, ,,,,possible. The date has to be before the cost report ending date and after 1/1/1966. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1000A,,"Worksheet A, columns 1 and 2, line 100 must be greater than zero. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1020A,,"For reclassifications reported on Worksheet A-6, the sum of all increases (columns 4 and 5)",,,,,,,, ,,,,must equal the sum of all decreases (columns 8 and 9). [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1025A,,"Worksheet A-6, column 1 must be present for each line with a column 3, 4, 5, 7, 8, or 9 entry.",,,,,,,, ,,,,There must be an entry on each line of columns 4 or 5 for each entry in column 3 and vice versa,,,,,,,, ,,,,and an entry on each line of columns 8 or 9 for each entry in column 7 and vice versa. All entries must,,,,,,,, ,,,,"be valid; for example, no salary adjustments on columns 3 and/or 7, lines 1-2 for capital [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1040A,,"For Worksheet A-8 adjustments on lines 1-2, or 4-8, if either columns 1, 2, or",,,,,,,, ,,,,"4 has an entry, then all three columns for that line must have entries and if any one of",,,,,,,, ,,,,"columns 0, 1, 2, or 4 for line 8 and subscripts thereof has an entry, then all four ",,,,,,,, ,,,,columns for that line must have entries. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1045A,,If there are any transactions with related organizations or home offices as defined in CMS,,,,,,,, ,,,,"Pub. 15-I, chapter 10 (Worksheet S-1, column 1, line 18 is ""Y""), Worksheet A-8-1, Part A,",,,,,,,, ,,,,columns 4 or 5 (amounts in columns 4 or 5 must have a parallel line number in column 1,,,,,,,, ,,,,"and vise versa), line 5 must be greater than zero; and Part B, column 1, any one of lines 1-5",,,,,,,, ,,,,"must contain any one of alpha characters A thru G. Conversely, if Worksheet S-1, column 1,",,,,,,,, ,,,,"line 18 is ""N"", Worksheet A-8-1 should not be present. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1000B,,"On Worksheet B-1, all statistical amounts must be greater than zero, except for ",,,,,,,, ,,,,reconciliation columns. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1005B,,"Worksheet B, column 7, line 100 must be greater than zero. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,1010B,,For each general service cost center with a net expense for cost allocation greater than zero,,,,,,,, ,,,,"(Worksheet B, columns 1 through 6, line 100), the corresponding total cost allocation",,,,,,,, ,,,,"statistics (Worksheet B-1; column 1, line 1; column 2, line 2, etc.) must also be greater than",,,,,,,, ,,,,zero. Exclude from this edit any column which uses accumulated cost as its basis for allocation,,,,,,,, ,,,,and any reconciliation column. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,1015B,,"For any column which uses accumulated cost as its bases of allocation (Worksheet B-1),",,,,,,,, ,,,,there may not exist on any statistical line an amount both in the reconciliation column,,,,,,,, ,,,,"and the accumulated cost column, including a negative one, simultaneously. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,Rev. 9,,,,,,,,,,38-225 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,09-11 ,,,, ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,,,,, TABLE 6 - EDITS,,,,, ,,,,,,,,,,,, ,,II. Level II Edits (Potential Rejection Errors),,,,,,,,,, ,,,,,,,,,,,, ,,,,"These conditions are usually, but not always, incorrect. These edit errors should be cleared",,,,,,,, ,,,,"when possible through the cost report. When corrections on the cost report are not feasible,",,,,,,,, ,,,,"provide additional information in schedules, note form, or any other manner as may be",,,,,,,, ,,,,"required by your fiscal intermediary. Failure to clear these errors in a timely fashion,",,,,,,,, ,,,,"as determined by your FI, may be grounds for withholding of payments.",,,,,,,, ,,,,,,,,,,,, ,,Edit,,,Condition,,,,,,, ,,,,,,,,,,,, ,,2000,,All type 3 records with numeric fields and a positive usage must have values equal to or greater,,,,,,,, ,,,,than zero (supporting documentation may be required for negative amounts). [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2005,,"Only elements set forth in Table 3, with subscripts as appropriate, are required in the ",,,,,,,, ,,,,file. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2010,,"The cost center code (position 21-24) (type 2 records) must be a code from Table 5, Cost",,,,,,,, ,,,,"Center Coding, and each cost center code must be unique. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,2015,,"Standard cost center lines, descriptions, and codes should not be changed. (See Table 5 for",,,,,,,, ,,,,standard descriptions and codes.) This edit applies to the standard line only and not subscripts,,,,,,,, ,,,,of that code. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2020,,All standard cost center codes must be entered on the designated standard cost center,,,,,,,, ,,,,line and subscripts thereof as indicated in Table 5. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2030,,The following standard cost centers listed below must be reported on the lines as indicated,,,,,,,, ,,,,and the corresponding cost center codes may only appear on the lines as indicated. ,,,,,,,, ,,,,No other cost center codes may be placed on these lines or subscripts of these lines.,,,,,,,, ,,,,[12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,,,, Cost Center,,,Line,, Code,, ,,,,,Cap. Rel. Costs-Bldg. & Fixt.,,,1,,0100-0149,, ,,,,,Cap. Rel. Costs-Moveable Equip.,,,2,,0200-0249,, ,,,,,Plant Operation and Maintenance,,,3,,0300-0349,, ,,,,,Transportation-Staff,,,4,,0400-0449,, ,,,,,Volunteer Services,,,5,,0500-0519,, ,,,,,Inpatient-General Care,,,10,,1000-1019,, ,,,,,Inpatient-Respite Care,,,11,,1100-1119,, ,,,,,Physician Services,,,15,,1500-1519,, ,,,,,Nursing Care,,,16,,1600-1619,, ,,,,,Nursing Care-Continuous Home Care,,,16.20,,1620-1639,, ,,,,,Physical Therapy,,,17,,1700-1719,, ,,,,,Occupational therapy,,,18,,1800-1819,, ,,,,,Speech/Language Pathology,,,19,,1900-1919,, ,,,,,Medical Social Services,,,20,,2000-2019,, ,,,,,Spiritual Counseling,,,21,,2100-2119,, ,,,,,Dietary Counseling,,,22,,2200-2219,, ,,,,,Home Health Aide and Homemaker,,,24,,2400-2419,, ,,,,,HH Aide & Homemaker-Cont Home Care,,,24.20,,2420-2439,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,38-226,,,,,,,,,,Rev. 9 ,,09-11,,,,,FORM CMS-1984-99,,,,,3895 (Cont.) ,,,, ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,,,,, TABLE 6 - EDITS,,,,, ,,,,,,,,,,,, ,,Edit,,,Condition,,,,,,, ,,,,,,,,,,,, ,,,,,Drugs and Biological Infusion Therapy,,,30,,3000-3029,, ,,,,,Analgesics,,,30.30,,3030,, ,,,,,Sedatives/Hypnotics,,,30.31,,3031,, ,,,,,Durable Medical Equipment/Oxygen,,,31,,3100-3129,, ,,,,,Patient Transportation,,,32,,3200-3229,, ,,,,,Imaging Services,,,33,,3300-3329,, ,,,,,Labs and Diagnostics,,,34,,3400-3429,, ,,,,,Med. Supplied charged to patients,,,35,,3500-3529,, ,,,,,Outpatient Services(incl E/R Dept.),,,36,,3600-3629,, ,,,,,Radiation Therapy,,,37,,3700-3729,, ,,,,,Chemotherapy,,,38,,3800-3829,, ,,,,,Bereavement Program Cost,,,50,,5000-5019,, ,,,,,Volunteer Program Cost,,,51,,5100-5119,, ,,,,,Fundraising,,,52,,5200-5219,, ,,,,,,,,,,,, ,,2035,,Administrative and general cost center codes 0600 and 0621-0623 (standard and nonstandard),,,,,,,, ,,,,may only appear on line 6 and subscripts of line 6. Other nonstandard descriptions,,,,,,,, ,,,,"and codes may also appear on subscripts of line 6, but must be within the general",,,,,,,, ,,,,services cost center category. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2040,,"All calendar format dates must be edited for 10 character format, e.g., 01/01/1996 ",,,,,,,, ,,,,(MM/DD/YYYY). [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2045,,"All dates must be possible, e.g., no ""00"", no ""30"" or ""31"" of February. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,2015S,,"The hospice certification date (Worksheet S-1, column 1 and 2, line 4) should be on or before",,,,,,,, ,,,,"the cost report beginning date (Worksheet S-1, column 1, line 3). [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,2045S,,"Worksheet S-1, line 7 (type of control) must have a value of 1 through 13. (See Table 3B.)",,,,,,,, ,,,,[12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2100S,,"The following statistics from Worksheet S-1, Part II should be greater than or equal to zero: ",,,,,,,, ,,,,,,,,,,,, ,,,,a.,"Number of unduplicated days for the hospice (columns 1-5, lines 8-12) [12/31/2004];",,,,,,, ,,,,,,,,,,,, ,,,,b.,"Number of patients receiving hospice care (columns 1-5, line 13) [12/31/2004];",,,,,,, ,,,,,,,,,,,, ,,,,c.,Total number of unduplicated continuous care hours billable to Medicare,,,,,,, ,,,,,"(columns 1 and 3, line 14). [12/31/2004]",,,,,,, ,,,,,,,,,,,, ,,,,d.,"Average length of stay within a hospice (columns 1-5, line 15).[12/31/2004]",,,,,,, ,,,,,,,,,,,, ,,,,e.,"Unduplicated Census Count (columns 1-5, line 16).[12/31/2004]",,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,Rev. 9,,,,,,,,,,38-227 ,,3895 (Cont.),,,,,FORM CMS-1984-99,,,,,09-11 ,,,, ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 1984-99,,,,,,,, ,,,,,,, TABLE 6 - EDITS,,,,, ,,,,,,,,,,,, ,,Edit,,,Condition,,,,,,, ,,,,,,,,,,,, ,,2000A,,"Worksheet A-6, column 1 (reclassification code) must be one or two alpha characters. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,,,"Column headings (Worksheets B-1, and B) are required as indicated for edit 2000B and 2005B:",,,,,,,, ,,,,,,,,,,,, ,,2000B,,a.,"At least one cost center description (lines 1-3), at least one statistical bases label",,,,,,, ,,,,,"(lines 4-5), and one statistical bases code (line 6) (capital cost center lines only) must",,,,,,, ,,,,,be present for each general service cost center with cost greater than zero (Worksheet,,,,,,, ,,,,,"B-1, columns 1 through 6, line 100). Exclude any reconciliation columns from this",,,,,,, ,,,,,edit. [12/31/2004],,,,,,, ,,,,,,,,,,,, ,,2005B,,b.,"The column numbering among these worksheets must be consistent. For example, data",,,,,,, ,,,,,in capital related costs - buildings and fixtures is identified as coming from column 1,,,,,,, ,,,,,on all applicable worksheets. [12/31/2004],,,,,,, ,,,,,,,,,,,, ,,2000G,,Total assets on Worksheet G line 33 must equal total liabilities and fund balance. [12/31/2004],,,,,,,, ,,,,,,,,,,,, ,,2010G,,"Net income or loss (Worksheet G-2, Part II, column 1, line 16) should not equal zero. [12/31/2004]",,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,,,,,,,,,,, ,,38-228,,,,,,,,,,Rev. 9