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CMS Pub. 100-06, ch. 5, § 510.8

Proof of Net Disbursement per MCS Register Summary Report (HBDR6000) to the Month-to-Date Analysis of

activein force · 2026-08-25 – presentas-observed

Payments (HBDR2002 Report, Line G)- This attachment is an illustration of the electronic spreadsheet (Exhibit 1) that will be used to

input selected financial information from the detailed claims data file and MCS reports.

(Rev. 21, 08-01-03)

Section 510.8: Proof of Net Disbursement per MCS Register Summary Report

(HBDR6000)

to the Month-to-Date Analysis of Payments (HBDR2002 Report, Line

Col. A Col. B Col. C Col. D Col. E Col. F Col. G

Net Disbursement

Provider Beneficiary (System Issues)

Amounts Per Amounts Per Total Amounts HBDR2002 Line G / Differences

LINE DATE HBDR6000 HBDR6000 (B + C) Detail Data Report (D - E) REASON

171 12/1/2002 0.00 0.00 0.00 0.00 0.00

172 12/2/2002 56,797,987.94 370,831.57 57,168,819.51 57,168,819.51 0.00

173 12/3/2002 29,260,656.54 198,158.08 29,458,814.62 29,458,814.62 0.00

174 12/4/2002 26,639,387.24 140,182.25 26,779,569.49 26,779,569.49 0.00

175 12/5/2002 3,517,320.61 24,074.66 3,541,395.27 3,541,395.27 0.00

176 12/6/2002 37,581,035.44 304,482.82 37,885,518.26 37,885,518.26 0.00

177 12/7/2002 0.00 0.00 0.00 0.00 0.00

178 12/8/2002 0.00 0.00 0.00 0.00 0.00

179 12/9/2002 62,035,371.68 310,687.95 62,346,059.63 62,346,059.63 0.00

180 12/10/2002 7,304,404.76 82,582.85 7,386,987.61 7,386,987.61 0.00

181 12/11/2002 2,307,689.22 25,941.58 2,333,630.80 2,333,630.80 0.00

182 12/12/2002 1,887,402.09 33,731.17 1,921,133.26 1,921,133.26 0.00

183 12/13/2002 45,991,947.26 353,513.40 46,345,460.66 46,345,460.66 0.00

184 12/14/2002 0.00 0.00 0.00 0.00 0.00

185 12/15/2002 0.00 0.00 0.00 0.00 0.00

186 12/16/2002 55,267,001.36 282,256.56 55,549,257.92 55,549,257.92 0.00

187 12/17/2002 32,468,909.40 158,938.94 32,627,848.34 32,627,847.85 0.49

188 12/18/2002 25,867,280.72 86,172.96 25,953,453.68 25,953,453.68 0.00

189 12/19/2002 2,233,805.64 33,233.43 2,267,039.07 2,267,039.07 0.00

190 12/20/2002 38,529,814.78 323,031.57 38,852,846.35 38,852,846.35 0.00

191 12/21/2002 0.00 0.00 0.00 0.00 0.00

192 12/22/2002 0.00 0.00 0.00 0.00 0.00

193 12/23/2002 75,527,135.84 418,408.42 75,945,544.26 75,945,544.26 0.00

194 12/24/2002 0.00 0.00 0.00 0.00 0.00

195 12/25/2002 0.00 0.00 0.00 0.00 0.00

196 12/26/2002 25,872,664.06 86,909.27 25,959,573.33 25,959,573.33 0.00

197 12/27/2002 38,612,629.55 267,765.89 38,880,395.44 38,880,395.44 0.00

198 12/28/2002 0.00 0.00 0.00 0.00 0.00

199 12/29/2002 0.00 0.00 0.00 0.00 0.00

200 12/30/2002 75,266,723.33 472,291.46 75,739,014.79 75,739,014.79 0.00

201 12/31/2002 0.00 0.00 0.00 0.00 0.00

202

203 Totals 642,969,167.46 3,973,194.83 646,942,362.29 646,942,361.80 0.49

History

(Rev. 21, 08-01-03)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: ac15c314fa46aa0d6775c9e8ede50cf0c0eba14bcf14b692ee1cdee22f7fdf70

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