CMS Pub. 100-04, ch. 4, § 10.11.6

Specific CCRs

(Rev. 1657, Issued: 12-31-08, Effective: 01-01-09, Implementation: 01-05-09)

The contractors must use the applicable Statewide average urban or rural hospital default

ratio if the CCR calculated for a hospital paid under OPPS is greater than the upper limit

CCR in the file of overall OPPS hospital CCR limits on the CMS Web site.

In addition to the circumstances listed in §§10.11.6, 10.11.5, and 10.11.4 of this chapter, a

Medicare contractor also should use a Statewide average CCR if it is unable to determine an

accurate overall ancillary CCR for a hospital for whom accurate data with which to calculate

an operating CCR is not available. Further, the policies of §§10.11.3.1 and 10.11.3.2 can be

applied as an alternative to the Statewide average.

See §10.11.10 for the location of the Statewide CCRs and the upper limit above which

the contractor must use the Statewide CCR.

10.11.7 - Methodology for Calculation of Hospital Overall CCR for

Hospitals That Do Not Have Nursing and Paramedical Education

Programs for Cost Reporting Periods Beginning Before May 1, 2010,

Under Cost Report Form 2552-96

(Rev. 2296, Issued: 09-02-11, Effective: 10-01-11, Implementation: 10-03-11)

10.11.7.1 - Methodology for Calculation of Hospital Overall CCR for

Hospitals That Do Not Have Nursing and Paramedical Education

Programs for Cost Reporting Periods Beginning On or After May 1,

2010, Under Cost Report 2552-10

(Rev. 2296, Issued: 09-02-11, Effective: 10-01-11, Implementation: 10-03-11)

In calculating the hospital‘s costs or charges, do not include departmental CCRs and

charges for services that are not paid under the OPPS such as physical, occupational and

speech language therapies, clinical diagnostic laboratory services, ambulance, rural health

clinic services, non-implantable DME, etc. See §10.11.10 for the location of the list of

exact cost centers that shall be included in the calculation of the overall CCR.

Step 1 - Determining Overall Costs:

Calculate costs for each cost center by multiplying the departmental CCR for each cost

center (and subscripts thereof) that reflect services subject to the OPPS from Form CMS

2552-10, Worksheet C, Part I, Column 9 by the Medicare outpatient charges for that cost

center (and subscripts thereof) from Worksheet D, Part V, Columns 2, 3, and 4,. Sum the

costs calculated for each cost center to arrive at Medicare outpatient cost of services

subject to OPPS.

Step 2 - Determining Overall Charges: Calculate charges by summing the Medicare

outpatient charges from Form CMS 2552-10, Worksheet D, Part V, Columns 2, 3, and 4,

(and for each cost center (and subscripts thereof) that reflect services subject to the

OPPS.

Step 3 - Calculating the Overall CCR: Divide the costs from Step 1 by the charges from

Step 2 to calculate the hospital‘s Medicare outpatient CCR.

10.11.8 - Methodology for Calculation of Hospital Overall CCR for

Hospitals That Have Nursing and Paramedical Education Programs for

Cost Reporting Periods Beginning Before May 1, 2010, Under Cost

Report Form 2552-96

(Rev. 2296, Issued: 09-02-11, Effective: 10-01-11, Implementation: 10-03-11)

10.11.8.1 - Methodology for Calculation of Hospital Overall CCR for

Hospitals That Have Nursing and Paramedical Education Programs for

Cost Reporting Periods Beginning On or After May 1, 2010, Under Cost

Report 2552-10

(Rev. 2296, Issued: 09-02-11, Effective: 10-01-11, Implementation: 10-03-11)

Do not include departmental CCRs and charges for services not subject to the OPPS

(such as physical, occupational and speech language therapies, clinical diagnostic

laboratory services, ambulance, rural health clinic services, non-implantable DME, etc.)

in calculating the hospital‘s costs or charges. See §10.11.10 for the location of the list of

the exact cost centers that should be included in the overall CCR.

Step 1 -- Determining costs for each department:

From Worksheet B, Part 1 - Column 26, deduct the nursing and paramedical education

costs found on the applicable line in Columns -20, and 23 of Worksheet B, Part I to

calculate a cost for each cost center.

Exception: The costs for 9200 are not calculated on this worksheet. For cost center 9200,

Observation Beds (Non-Distinct Part), use the cost reported on Worksheet D-1, Part IV,

line 89, and deduct the nursing and paramedical education costs found on Worksheet D-

1, Part IV, line 93 and subscripts, column 5. See Step 3 below.

Step 2 - Determining charges for each department: From worksheet C, Part 1 - Column 8

(sum of columns 6 and 7), identify ―total charges.

Step 3 - Determining the CCRs for each department without nursing and paramedical

education costs: For each line, divide the costs from Step1 by the charges from Step 2 to

acquire CCRs for each line, without inclusion of nursing and paramedical education

costs. Exception: For cost center 9200, Observation Beds (Non-Distinct Part), use the

cost reported on Worksheet D-1, Part IV, line 89, and deduct the nursing and paramedical

education costs found on Worksheet D-1, Part IV, line 93 and subscripts, column 5.

Step 4 - Determining Overall Costs: Multiply the CCR in step 3 by the Medicare

outpatient charges for that cost center (and subscripts thereof) from Worksheet D Part V,

Columns 2, 3, and 4,. Sum the costs calculated for each cost center to arrive at Medicare

outpatient cost of services subject to OPPS.

Step 5 - Determining Overall Charges: Calculate charges by summing the Medicare

outpatient charges from Form CMS 2552-10, Worksheet D, Part V, Columns 2, 3, and 4,

for each cost center (and subscripts thereof) that reflect service subject to the OPPS.

Step 6 - Calculating the Overall CCR: Divide the costs from Step 4 by the charges from

step 5 to calculate the hospital‘s Medicare outpatient CCR.