US · guidance
CMS Pub. 100-06, ch. 6, § 20.2
Checking Reports
A3-3893.2
Before submitting Form D to CMS, the intermediary checks its completeness and
arithmetical correctness. This check not only ensures accuracy but also uncovers other
errors and inconsistencies. It uses the following checklist:
For each column:
• Line 1 + 2 = 3.
• Line 7 + 8 = 6.
• Line 10 + 11 = 9.
• Line 6 + 9 = 12.
• Line 3 + 4 - 12 = 13.
• Line 5 must be equal to or less than line 4.
• Line 14 must be equal to or less than line 13.
• Line 15 must be equal to or less than line 14.
• Line 18 + 19 + 20 + 21 = 17.
• Line 23 + 24 + 25 + 26 = 22.
• Line 28 + 29 + 30 + 31 = 27.
• Line 33 must be equal to or less than line 32.
• Line 35 + 36 + 37 = 34.
• Columns 2 + 3 + 4 + 5 + 6 = 1 for lines 1-33.
• Columns 2 + 3 = 1 for lines 34-37.
The intermediary bases all data reported on the CMS-1566 on actual counts and not on
any types of estimates or samples.
History
(Rev. 6, 08-30-02)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
93a4511bfd2a819b71352072dc7162964a9000eda8863fffd3747694fa5b2259
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