CMS Pub. 100-16, ch. mc86c17b, § 40

Providers using Form CMS-2552 will prepare their cost reports and submit them to the

FFS system just as they now do, except that the cost of only Medicare patients who are

not members of the HMO/CMP will be apportioned and submitted to the FFS system for

payment.

When an HMO/CMP has elected to have CMS process the bills for some hospitals and

SNFs furnishing services to the organization’s Medicare enrollees, the affected providers

will prepare their cost reports and submit them to the FFS system just as they do now.

The cost of the organization’s enrollees should be included with the provider’s other

Medicare patients, apportioned, and submitted to the intermediary for payment.

In addition, the provider will prepare a separate set of apportionment and settlement

worksheets apportioning the costs to the organization’s Medicare enrollees. A separate

set of worksheets will be needed for each organization with which the provider has an

agreement to have payment made directly by the HMO/CMP. Each set of worksheets will

apportion each cost center between the applicable group of Medicare beneficiaries and all

other provider patients.

For example, HMO A has a bill processing contract with the provider. The provider will

submit to the HMO the set of worksheets which will reflect the cost of providing covered

services to the HMO’s Medicare enrollees. The apportionment ratios by cost center

would be:

(Total Costs) times (Charges for the HMO’s Medicare enrollees)

= Total Charges

Ratios by cost centers on the worksheets for non-HMO/CMP Medicare patients would

be:

(Total Costs) times (Charges for Medicare patients that are not members of the

HMO/CMP)

= Total Charges

All other schedules currently required will be completed under existing instructions.

Copies of all schedules will be sent to the FFS system for processing and settlement.