Medicare cost formulas
The following table lists full calculations and cost report fields for all cost measures.
| General Category | Measure | Formula | Medicare Cost Report Fields |
|---|---|---|---|
|
Routine Care |
Routine Direct Percentage Numerator |
|
Worksheet B PART 1, Row 25, Column 0 |
|
Routine Care |
Routine Direct Percentage Denominator |
|
Worksheet B PART 1, Row 25, Column 27 |
|
Routine Care |
Routine Cost Per Day for Private Room, Semi Private Room, Ward Cost Per Day |
|
Worksheet D-1, Row 38, Column 1 |
|
Routine Care |
Private Room Direct Cost Per Patient |
Routine Cost Per Day * Number of Private Days for a Patient* Routine Direct Percentage Numerator / Routine Direct Percentage Denominator |
Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27 |
|
Routine Care |
Private Room Indirect Cost Per Patient |
Routine Cost Per Day * Number of Private Days for a Patient* (1 - Routine Direct Percentage Numerator / Routine Direct Percentage Denominator) |
Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) |
|
Routine Care |
Private Room Total Cost |
Private Room Direct Cost + Private Room Indirect Cost |
(Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27)) |
|
Routine Care |
Semi-Private Room Direct Cost Per Patient |
Routine Cost Per Day * Number of Semi-Private Days for a Patient* Routine Direct Percentage Numerator / Routine Direct Percentage Denominator |
Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27 |
|
Routine Care |
Semi-Private Room Indirect Cost Per Patient |
Routine Cost Per Day * Number of Semi-Private Days for a Patient* (1 - Routine Direct Percentage Numerator / Routine Direct Percentage Denominator) |
Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) |
|
Routine Care |
Semi-Private Room Total Cost |
Semi-Private Room Direct Cost + Semi-Private Room Indirect Cost |
(Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27)) |
|
Routine Care |
Ward Room Direct Cost Per Patient |
Routine Cost Per Day * Number of Ward Days for a Patient* Routine Direct Percentage Numerator / Routine Direct Percentage Denominator |
Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27 |
|
Routine Care |
Ward Room Indirect Cost Per Patient |
Routine Cost Per Day * Number of Ward Days for a Patient* (1 - Routine Direct Percentage Numerator / Routine Direct Percentage Denominator) |
Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) |
|
Routine Care |
Ward Room Total Cost |
Ward Room Direct Cost + Ward Room Indirect Cost |
(Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27)) |
|
Routine Care |
Routine Direct Cost per Patient |
Private Direct Cost Per Patient plus Semi Private Cost Per Patient plus Ward Direct Cost Per Patient |
(Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) |
|
Routine Care |
Routine Indirect Cost per Patient |
Private Indirect Cost Per Patient plus Semi Private indirect Cost Per Patient plus Ward indirect Cost Per Patient |
(Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27)) + (Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27)) + (Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27)) |
|
Routine Care |
Routine Total Cost per Patient |
Private Total Cost Per Patient plus Semi Private Total Cost Per Patient plus Ward Total Cost Per Patient |
((Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27))) + ((Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Semi-Private Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27))) + ((Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27) + (Worksheet D-1, Row 38, Column 1 * Number of Ward Days for a Patient* (1 - Worksheet B PART 1, Row 25, Column 0 / Worksheet B PART 1, Row 25, Column 27))) |
|
Intensive Care |
Intensive Care Direct Percentage Numerator |
|
Worksheet B PART 1, Row 26, Column 0 + Worksheet B PART 1, Row 28, Column 0 + Worksheet B PART 1, Row 29, Column 0 + Worksheet B PART 1, Row 30, Column 0 |
|
Intensive Care |
Intensive Care Direct Percentage Denominator |
|
Worksheet PART 1, Row 26, Column 27 + Worksheet PART 1, Row 28, Column 27 + Worksheet PART 1, Row 29, Column 27 + Worksheet PART 1, Row 30, Column 27 |
|
Intensive Care |
Intensive Care Cost |
|
Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1 |
|
Intensive Care |
Intensive Care Number of Days |
|
Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1 |
|
Intensive Care |
Intensive Cost Per Day |
Total Intensive Care Costs / Total Intensive Care Days |
(Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1) / (Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2) |
|
Intensive Care |
Intensive Care Direct Cost for a Patient |
Intensive Care Days for a Patient * Intensive Care Cost Per Day* Intensive Care Direct Cost Numerator / Intensive Care Direct Cost Denominator |
(Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2) * ((Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1) / (Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2)) * (Worksheet B PART 1, Row 26, Column 0 + Worksheet B PART 1, Row 28, Column 0 + Worksheet B PART 1, Row 29, Column 0 + Worksheet B PART 1, Row 30, Column 0) / (Worksheet B PART 1, Row 26, Column 27 + Worksheet B PART 1, Row 28, Column 27 + Worksheet B PART 1, Row 29, Column 27 + Worksheet B PART 1, Row 30, Column 27) |
|
Intensive Care |
Intensive Care Indirect Cost for a Patient |
Intensive Care Days for a Patient * Intensive Care Cost Per Day* (1 - Intensive Care Direct Cost Numerator / Intensive Care Direct Cost Denominator) |
(Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2) * ((Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1) / (Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2)) * (1 - (Worksheet B PART 1, Row 26, Column 0 + Worksheet B PART 1, Row 28, Column 0 + Worksheet B PART 1, Row 29, Column 0 + Worksheet B PART 1, Row 30, Column 0) / (Worksheet B PART 1, Row 26, Column 27 + Worksheet B PART 1, Row 28, Column 27 + Worksheet B PART 1, Row 29, Column 27 + Worksheet B PART 1, Row 30, Column 27)) |
|
Intensive Care |
Intensive Care Costs Per Patient |
Intensive Care Direct Cost + Intensive Care Indirect Cost |
((Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2) * ((Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1) / (Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2)) * (Worksheet B PART 1, Row 26, Column 0 + Worksheet B PART 1, Row 28, Column 0 + Worksheet B PART 1, Row 29, Column 0 + Worksheet B PART 1, Row 30, Column 0) / (Worksheet B PART 1, Row 26, Column 27 + Worksheet B PART 1, Row 28, Column 27 + Worksheet B PART 1, Row 29, Column 27 + Worksheet B PART 1, Row 30, Column 27)) + (Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2) * ((Worksheet D-1 Part 2, Row 43, Column 1 + Worksheet D-1 Part 2, Row 45, Column 1 + Worksheet D-1 Part 2, Row 46, Column 1 + Worksheet D-1 Part 2, Row 47, Column 1) / (Worksheet D-1 Part 2, Row 43, Column 2 + Worksheet D-1 Part 2, Row 45, Column 2 + Worksheet D-1 Part 2, Row 46, Column 2 + Worksheet D-1 Part 2, Row 47, Column 2)) * (1 - (Worksheet B PART 1, Row 26, Column 0 + Worksheet B PART 1, Row 28, Column 0 + Worksheet B PART 1, Row 29, Column 0 + Worksheet B PART 1, Row 30, Column 0) / (Worksheet B PART 1, Row 26, Column 27 + Worksheet B PART 1, Row 28, Column 27 + Worksheet B PART 1, Row 29, Column 27 + Worksheet B PART 1, Row 30, Column 27)) |
|
Coronary Care |
Coronary Care Direct Percentage Numerator |
|
Worksheet PART 1, Row 27, Column 0 |
|
Coronary Care |
Coronary Care Direct Percentage Denominator |
|
Worksheet PART 1, Row 27, Column 27 |
|
Coronary Care |
Cost |
|
Worksheet D-1 Part 2, Row 44, Column 1 |
|
Coronary Care |
Number of Days |
|
Worksheet D-1 Part 2, Row 44, Column 2 |
|
Coronary Care |
Coronary Cost Per Day |
Total Costs / Total Days |
Worksheet D-1 Part 2, Row 44, Column 1 / Worksheet D-1 Part 2, Row 44, Column 2 |
|
Coronary Care |
Coronary Care Direct Cost for a Patient |
Coronary Care Days for a Patient * Coronary Care Cost Per Day* Coronary Care Direct Cost Numerator / Coronary Care Direct Cost Denominator |
Worksheet D-1 Part 2, Row 44, Column 2 * (Worksheet D-1 Part 2, Row 44, Column 1 / Worksheet D-1 Part 2, Row 44, Column 2) * Worksheet PART 1, Row 27, Column 0 / Worksheet PART 1, Row 27, Column 27 |
|
Coronary Care |
Coronary Care Indirect Cost for a Patient |
Coronary Care Days for a Patient * Coronary Care Cost Per Day* (1 - Coronary Care Direct Cost Numerator / Coronary Care Direct Cost Denominator) |
Worksheet D-1 Part 2, Row 44, Column 2 * (Worksheet D-1 Part 2, Row 44, Column 1 / Worksheet D-1 Part 2, Row 44, Column 2) * (1 - Worksheet PART 1, Row 27, Column 0 / Worksheet PART 1, Row 27, Column 27) |
|
Coronary Care |
Coronary Care Costs Per Patient |
Coronary Care Direct Cost + Coronary Care Indirect Cost |
(Worksheet D-1 Part 2, Row 44, Column 2 * (Worksheet D-1 Part 2, Row 44, Column 1 / Worksheet D-1 Part 2, Row 44, Column 2) * Worksheet PART 1, Row 27, Column 0 / Worksheet PART 1, Row 27, Column 27) + (Worksheet D-1 Part 2, Row 44, Column 2 * (Worksheet D-1 Part 2, Row 44, Column 1 / Worksheet D-1 Part 2, Row 44, Column 2) * (1 - Worksheet PART 1, Row 27, Column 0 / Worksheet PART 1, Row 27, Column 27)) |
|
Other |
Other Direct Percentage Numerator |
|
Worksheet PART 1, Row 58, Column 0 + Worksheet PART 1, Row 59, Column 0 + Worksheet PART 1, Row 62, Column 0 + Worksheet PART 1, Row 68, Column 0 |
|
Other |
Other Direct Percentage Denominator |
|
Worksheet PART 1, Row 58, Column 27 + Worksheet PART 1, Row 59, Column 27 + Worksheet PART 1, Row 62, Column 27 + Worksheet PART 1, Row 68, Column 27 |
|
Other |
Costs |
|
Worksheet D-4, Row 58, Column 3 + Worksheet D-4, Row 59, Column 3 + Worksheet D-4, Row 62, Column 3 + Worksheet D-4, Row 68, Column 3 |
|
Other |
Charges |
|
Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2 + Worksheet D-4, Row 68, Column 2 |
|
Other |
Other Cost-to-Charges Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 58, Column 3 + Worksheet D-4, Row 59, Column 3 + Worksheet D-4, Row 62, Column 3) / (Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2) |
|
Other |
Other Direct Cost for a Patient |
Other Charges for a Patient * Other Ratio* Other Direct Cost Numerator /Other Direct Cost Denominator |
(Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2) * ((Worksheet D-4, Row 58, Column 3 + Worksheet D-4, Row 59, Column 3 + Worksheet D-4, Row 62, Column 3) / (Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2)) * (Worksheet PART 1, Row 58, Column 0 + Worksheet PART 1, Row 59, Column 0 + Worksheet PART 1, Row 62, Column 0 + Worksheet PART 1, Row 68, Column 0) / (Worksheet PART 1, Row 58, Column 27 + Worksheet PART 1, Row 59, Column 27 + Worksheet PART 1, Row 62, Column 27 + Worksheet PART 1, Row 68, Column 27) |
|
Other |
Other Indirect Cost for a Patient |
Other Charges for a Patient * Other Ratio* (1- Other Direct Cost Numerator /Other Direct Cost Denominator) |
(Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2) * ((Worksheet D-4, Row 58, Column 3 + Worksheet D-4, Row 59, Column 3 + Worksheet D-4, Row 62, Column 3) / (1 - (Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2)) * (Worksheet PART 1, Row 58, Column 0 + Worksheet PART 1, Row 59, Column 0 + Worksheet PART 1, Row 62, Column 0 + Worksheet PART 1, Row 68, Column 0) / (Worksheet PART 1, Row 58, Column 27 + Worksheet PART 1, Row 59, Column 27 + Worksheet PART 1, Row 62, Column 27 + Worksheet PART 1, Row 68, Column 27)) |
|
Other |
Total Other Costs |
Other Direct Costs + Other Indirect Costs |
((Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2) * ((Worksheet D-4, Row 58, Column 3 + Worksheet D-4, Row 59, Column 3 + Worksheet D-4, Row 62, Column 3) / (Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2)) * (Worksheet PART 1, Row 58, Column 0 + Worksheet PART 1, Row 59, Column 0 + Worksheet PART 1, Row 62, Column 0 + Worksheet PART 1, Row 68, Column 0) / (Worksheet PART 1, Row 58, Column 27 + Worksheet PART 1, Row 59, Column 27 + Worksheet PART 1, Row 62, Column 27 + Worksheet PART 1, Row 68, Column 27)) + (Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2) * ((Worksheet D-4, Row 58, Column 3 + Worksheet D-4, Row 59, Column 3 + Worksheet D-4, Row 62, Column 3) / (1 - (Worksheet D-4, Row 58, Column 2 + Worksheet D-4, Row 59, Column 2 + Worksheet D-4, Row 62, Column 2)) * (Worksheet PART 1, Row 58, Column 0 + Worksheet PART 1, Row 59, Column 0 + Worksheet PART 1, Row 62, Column 0 + Worksheet PART 1, Row 68, Column 0) / (Worksheet PART 1, Row 58, Column 27 + Worksheet PART 1, Row 59, Column 27 + Worksheet PART 1, Row 62, Column 27 + Worksheet PART 1, Row 68, Column 27)) |
|
Pharmacy |
Pharmacy Direct Percentage Numerator |
|
Worksheet PART 1, Row 48, Column 0 + Worksheet PART 1, Row 56, Column 0 |
|
Pharmacy |
Pharmacy Direct Percentage Denominator |
|
Worksheet PART 1, Row 48, Column 27 + Worksheet PART 1, Row 56, Column 27 |
|
Pharmacy |
Inpatient Percentage Pharmacy Numerator |
|
Worksheet C Part 1, Row 48, Column 6 + Worksheet C Part 1, Row 56, Column 6 |
|
Pharmacy |
Inpatient Percentage Pharmacy Denominator |
|
Worksheet C Part 1, Row 48, Column 8 + Worksheet C Part 1, Row 56, Column 8 |
|
Pharmacy |
Cost |
|
Worksheet D-4, Row 48, Column 3 + Worksheet D-4, Row 56, Column 3 |
|
Pharmacy |
Charges |
|
Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2 |
|
Pharmacy |
Pharmacy Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) / (Worksheet D-4, Row 48, Column 3 + Worksheet D-4, Row 56, Column 3) |
|
Pharmacy |
Pharmacy Direct Cost for a Patient |
Pharmacy Charges for a Patient * Pharmacy Ratio* Pharmacy Direct Cost Numerator / Pharmacy Direct Cost Denominator |
(Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) * ((Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) / (Worksheet D-4, Row 48, Column 3 + Worksheet D-4, Row 56, Column 3)) * (Worksheet PART 1, Row 48, Column 0 + Worksheet PART 1, Row 56, Column 0) / (Worksheet PART 1, Row 48, Column 27 + Worksheet PART 1, Row 56, Column 27) |
|
Pharmacy |
Pharmacy Indirect Cost for a Patient |
Pharmacy Charges for a Patient * Pharmacy Ratio* (1 - Pharmacy Direct Cost Numerator / Pharmacy Direct Cost Denominator) |
(Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) * ((Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) / (Worksheet D-4, Row 48, Column 3 + Worksheet D-4, Row 56, Column 3)) * (1 - (Worksheet PART 1, Row 48, Column 0 + Worksheet PART 1, Row 56, Column 0) / (Worksheet PART 1, Row 48, Column 27 + Worksheet PART 1, Row 56, Column 27)) |
|
Pharmacy |
Total Pharmacy Costs |
Pharmacy Direct Costs + Pharmacy Indirect Costs |
((Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) * ((Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) / (Worksheet D-4, Row 48, Column 3 + Worksheet D-4, Row 56, Column 3)) * (Worksheet PART 1, Row 48, Column 0 + Worksheet PART 1, Row 56, Column 0) / (Worksheet PART 1, Row 48, Column 27 + Worksheet PART 1, Row 56, Column 27)) + ((Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) * ((Worksheet D-4, Row 48, Column 2 + Worksheet D-4, Row 56, Column 2) / (Worksheet D-4, Row 48, Column 3 + Worksheet D-4, Row 56, Column 3)) * (1 - (Worksheet PART 1, Row 48, Column 0 + Worksheet PART 1, Row 56, Column 0) / (Worksheet PART 1, Row 48, Column 27 + Worksheet PART 1, Row 56, Column 27))) |
|
Medical Surgical Supplies |
Medical Supplies Direct Percentage Numerator |
|
Worksheet PART 1, Row 55, Column 0 |
|
Medical Surgical Supplies |
Medical Supplies Direct Percentage Denominator |
|
Worksheet PART 1, Row 55, Column 27 |
|
Medical Surgical Supplies |
Cost |
|
Worksheet D-4, Row 55, Column 3 |
|
Medical Surgical Supplies |
Charges |
|
Worksheet D-4, Row 55, Column 2 |
|
Medical Surgical Supplies |
Medical Supplies Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 55, Column 3) / (Worksheet D-4, Row 55, Column 2) |
|
Medical Surgical Supplies |
Medical Supplies Direct Cost for a Patient |
Medical Supplies Charges for a Patient * Medical Supplies Ratio * Medical Supplies Direct Cost Numerator / Medical Supplies Direct Cost Denominator |
Worksheet D-4, Row 55, Column 2 * (Worksheet D-4, Row 55, Column 3) / (Worksheet D-4, Row 55, Column 2) * Worksheet PART 1, Row 55, Column 0 / Worksheet PART 1, Row 55, Column 27 |
|
Medical Surgical Supplies |
Medical Supplies Indirect Cost for a Patient |
Medical Supplies Charges for a Patient * Medical Supplies Ratio * (1 - Medical Supplies Direct Cost Numerator / Medical Supplies Direct Cost Denominator) |
Worksheet D-4, Row 55, Column 2 * (Worksheet D-4, Row 55, Column 3) / (Worksheet D-4, Row 55, Column 2) * (1 - Worksheet PART 1, Row 55, Column 0 / Worksheet PART 1, Row 55, Column 27) |
|
Medical Surgical Supplies |
Total Medical Supplies Cost |
Direct Medical Supplies Cost + Indirect Medical Supplies Cost |
(Worksheet D-4, Row 55, Column 2 * (Worksheet D-4, Row 55, Column 3) / (Worksheet D-4, Row 55, Column 2) * Worksheet PART 1, Row 55, Column 0 / Worksheet PART 1, Row 55, Column 27) + (Worksheet D-4, Row 55, Column 2 * (Worksheet D-4, Row 55, Column 3) / (Worksheet D-4, Row 55, Column 2) * (1 - Worksheet PART 1, Row 55, Column 0 / Worksheet PART 1, Row 55, Column 27)) |
|
DME* |
DME Direct Percentage Numerator |
|
Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0 |
|
DME* |
DME Direct Percentage Denominator |
|
Worksheet PART 1, Row 66, Column 27 + Worksheet PART 1, Row 67, Column 27 |
|
DME* |
Costs |
|
Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3 |
|
DME* |
Charges |
|
Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2 |
|
DME* |
DME Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) |
|
DME* |
DME Direct Cost for a Patient |
DME Charges for a Patient * DME Ratio* DME Direct Costs Numerator / DME Direct Cost Denominator |
(Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * ((Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2)) |
|
DME* |
DME Indirect Cost for a Patient |
DME Charges for a Patient * DME Ratio*( 1 - DME Direct Costs Numerator / DME Direct Cost Denominator) |
(Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * (1 - (Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2)) |
|
DME* |
Total DME Costs |
DME Direct Costs + DME Indirect Costs |
((Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * ((Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2))) + ((Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * (1 - (Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2))) |
|
Used DME* |
Used DME Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) |
|
Used DME |
Used DME Direct Cost for a Patient |
Used DME Charges for a Patient * Used DME Ratio* DME Direct Cost Numerator / DME Direct Cost Denominator |
(Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * ((Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2)) |
|
Used DME* |
Used DME indirect Cost for a Patient |
Used DME Charges for a Patient * Used DME Ratio*(1 - DME Direct Cost Numerator / DME Direct Cost Denominator) |
(Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * (1 - (Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2)) |
|
Used DME* |
Total Used DME Costs |
Used DME Direct Costs + Used DME Indirect Costs |
((Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * ((Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2))) + ((Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2) * ((Worksheet D-4, Row 66, Column 3 + Worksheet D-4, Row 67, Column 3) / (Worksheet D-4, Row 66, Column 2 + Worksheet D-4, Row 67, Column 2)) * (1 - (Worksheet PART 1, Row 66, Column 0 + Worksheet PART 1, Row 67, Column 0) / (Worksheet PART 1, Row 66, Column 2 + Worksheet PART 1, Row 67, Column 2))) |
|
Physical Therapy |
Physical Therapy Direct Percentage Numerator |
|
Worksheet PART 1, Row 50, Column 0 |
|
Physical Therapy |
Physical Therapy Direct Percentage Denominator |
|
Worksheet PART 1, Row 50, Column 27 |
|
Physical Therapy |
Physical Therapy Cost-to-Charge Ratio |
Supplied on Cost Report as Physical Therapy Cost-to-Charges Ratio |
Worksheet D-4, Row 50, Column 1 |
|
Physical Therapy |
Physical Therapy Direct Cost for a Patient |
Physical Therapy Charges for a Patient * Physical Therapy Ratio * Physical Therapy Direct Cost Numerator / Physical Therapy Direct Cost Denominator |
Physical Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 50, Column 1 * Worksheet PART 1, Row 50, Column 0 / Worksheet PART 1, Row 50, Column 27 |
|
Physical Therapy |
Physical Therapy Indirect Cost for a Patient |
Physical Therapy Charges for a Patient * Physical Therapy Ratio * (1 - Physical Therapy Direct Cost Numerator / Physical Therapy Direct Cost Denominator) |
Physical Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 50, Column 1 * (1 - Worksheet PART 1, Row 50, Column 0 / Worksheet PART 1, Row 50, Column 27) |
|
Physical Therapy |
Total Physical Therapy Costs |
Physical Therapy Direct Costs + Physical Therapy Indirect Costs |
(Physical Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 50, Column 1 * Worksheet PART 1, Row 50, Column 0 / Worksheet PART 1, Row 50, Column 27) + (Physical Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 50, Column 1 * (1 - Worksheet PART 1, Row 50, Column 0 / Worksheet PART 1, Row 50, Column 27)) |
|
Occupational Therapy |
Occupational Therapy Direct Percentage Numerator |
|
Worksheet PART 1, Row 51, Column 0 |
|
Occupational Therapy |
Occupational Therapy Direct Percentage Denominator |
|
Worksheet PART 1, Row 51, Column 27 |
|
Occupational Therapy |
Occupational Therapy Cost-to-Charge Ratio |
Supplied on Cost Report as Occupational Therapy Cost-to-Charges Ratio |
Worksheet D-4, Row 51, Column 1 |
|
Occupational Therapy |
Occupational Therapy Direct Cost for a Patient |
Occupational Therapy Charges for a Patient * Occupational Therapy Ratio * Occupational Therapy Direct Cost Numerator / Occupational Therapy Direct Cost Denominator |
Occupational Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 51, Column 1 * Worksheet PART 1, Row 51, Column 0 / Worksheet PART 1, Row 51, Column 27 |
|
Occupational Therapy |
Occupational Therapy Indirect Cost for a Patient |
Occupational Therapy Charges for a Patient * Occupational Therapy Ratio * (1 - Occupational Therapy Direct Cost Numerator / Occupational Therapy Direct Cost Denominator) |
Occupational Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 51, Column 1 * (1 - Worksheet PART 1, Row 51, Column 0 / Worksheet PART 1, Row 51, Column 27) |
|
Occupational Therapy |
Total Occupational Therapy Costs |
Occupational Therapy Direct Costs + Occupational Therapy Indirect Costs |
(Occupational Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 51, Column 1 * Worksheet PART 1, Row 51, Column 0 / Worksheet PART 1, Row 51, Column 27) + (Occupational Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 51, Column 1 * (1 - Worksheet PART 1, Row 51, Column 0 / Worksheet PART 1, Row 51, Column 27)) |
|
Speech Therapy |
Speech Therapy Direct Percentage Numerator |
|
Worksheet PART 1, Row 52, Column 0 |
|
Speech Therapy |
Speech Therapy Direct Percentage Denominator |
|
Worksheet PART 1, Row 52, Column 27 |
|
Speech Therapy |
Speech Therapy Cost-to-Charge Ratio |
Supplied on Cost Report as Speech Therapy Cost-to-Charges Ratio |
Worksheet D-4, Row 52, Column 1 |
|
Speech Therapy |
Speech Therapy Direct Cost for a Patient |
Speech Therapy Charges for a Patient * Speech Therapy Ratio * Speech Therapy Direct Cost Numerator / Speech Therapy Direct Cost Denominator |
Speech Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 52, Column 1 * Worksheet PART 1, Row 52, Column 0 / Worksheet PART 1, Row 52, Column 27 |
|
Speech Therapy |
Speech Therapy Indirect Cost for a Patient |
Speech Therapy Charges for a Patient * Speech Therapy Ratio * (1 - Speech Therapy Direct Cost Numerator / Speech Therapy Direct Cost Denominator) |
Speech Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 52, Column 1 * (1 - Worksheet PART 1, Row 52, Column 0 / Worksheet PART 1, Row 52, Column 27) |
|
Speech Therapy |
Total Speech Therapy Costs |
Speech Therapy Direct Costs + Speech Therapy Indirect Costs |
(Speech Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 52, Column 1 * Worksheet PART 1, Row 52, Column 0 / Worksheet PART 1, Row 52, Column 27) + (Speech Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 52, Column 1 * (1 - Worksheet PART 1, Row 52, Column 0 / Worksheet PART 1, Row 52, Column 27)) |
|
Inhalation Therapy |
Inhalation Therapy Direct Percentage Numerator |
|
Worksheet PART 1, Row 49, Column 0 |
|
Inhalation Therapy |
Inhalation Therapy Direct Percentage Denominator |
|
Worksheet PART 1, Row 49, Column 27 |
|
Inhalation Therapy |
Inhalation Therapy Cost-to-Charge Ratio |
Supplied on Cost Report as Inhalation Therapy Cost-to-Charges Ratio |
Worksheet D-4, Row 49, Column 1 |
|
Inhalation Therapy |
Inhalation Therapy Direct Cost for a Patient |
Inhalation Therapy Charges for a Patient * Inhalation Therapy Ratio * Inhalation Therapy Direct Cost Numerator / Inhalation Therapy Direct Cost Denominator |
Inhalation Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 49, Column 1 * Worksheet PART 1, Row 49, Column 0 / Worksheet PART 1, Row 49, Column 27 |
|
Inhalation Therapy |
Inhalation Therapy Indirect Cost for a Patient |
Inhalation Therapy Charges for a Patient * Inhalation Therapy Ratio * (1 - Inhalation Therapy Direct Cost Numerator / Inhalation Therapy Direct Cost Denominator) |
Inhalation Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 49, Column 1 * (1 - Worksheet PART 1, Row 49, Column 0 / Worksheet PART 1, Row 49, Column 27) |
|
Inhalation Therapy |
Total Inhalation Therapy Costs |
Inhalation Therapy Direct Costs + Inhalation Therapy Indirect Costs |
(Inhalation Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 49, Column 1 * Worksheet PART 1, Row 49, Column 0 / Worksheet PART 1, Row 49, Column 27) + (Inhalation Therapy Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 49, Column 1 * (1 - Worksheet PART 1, Row 49, Column 0 / Worksheet PART 1, Row 49, Column 27)) |
|
Blood |
Blood Direct Percentage Numerator |
|
Worksheet PART 1, Row 46, Column 0 |
|
Blood |
Blood Direct Percentage Denominator |
|
Worksheet PART 1, Row 46, Column 27 |
|
Blood |
Blood Cost-to-Charge Ratio |
Supplied on Cost Report as Blood Cost-to-Charges Ratio |
Worksheet D-4, Row 46, Column 1 |
|
Blood |
Blood Direct Cost for a Patient |
Blood Charges for a Patient * Blood Ratio * Blood Direct Cost Numerator / Blood Direct Cost Denominator |
Blood Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 46, Column 1 * Worksheet PART 1, Row 46, Column 0 / Worksheet PART 1, Row 46, Column 27 |
|
Blood |
Blood Indirect Cost for a Patient |
Blood Charges for a Patient * Blood Ratio * (1 - Blood Direct Cost Numerator / Blood Direct Cost Denominator) |
Blood Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 46, Column 1 * (1 - Worksheet PART 1, Row 46, Column 0 / Worksheet PART 1, Row 46, Column 27) |
|
Blood |
Total Blood Costs |
Blood Direct Costs + Blood Indirect Costs |
(Blood Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 46, Column 1 * Worksheet PART 1, Row 46, Column 0 / Worksheet PART 1, Row 46, Column 27) + (Blood Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 46, Column 1 * (1 - Worksheet PART 1, Row 46, Column 0 / Worksheet PART 1, Row 46, Column 27)) |
|
Blood Administration |
Blood Admin Direct Percentage Numerator |
|
Worksheet PART 1, Row 47, Column 0 |
|
Blood Administration |
Blood Admin Direct Percentage Denominator |
|
Worksheet PART 1, Row 47, Column 27 |
|
Blood Administration |
Blood Administration Cost-to-Charge Ratio |
Supplied on Cost Report as Blood Administration Cost-to-Charges Ratio |
Worksheet D-4, Row 47, Column 1 |
|
Blood Administration |
Blood Admin Direct Cost for a Patient |
Blood Admin Charges for a Patient * Blood Admin Ratio * Blood Admin Direct Cost Numerator / Blood Admin Direct Cost Denominator |
Blood Administration Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 47, Column 1 * Worksheet PART 1, Row 47, Column 0 / Worksheet PART 1, Row 47, Column 27 |
|
Blood Administration |
Blood Admin Indirect Cost for a Patient |
Blood Admin Charges for a Patient * Blood Admin Ratio * (1 - Blood Admin Direct Cost Numerator / Blood Admin Direct Cost Denominator) |
Blood Administration Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 47, Column 1 * (1 - Worksheet PART 1, Row 47, Column 0 / Worksheet PART 1, Row 47, Column 27) |
|
Blood Administration |
Total Blood Admin Costs |
Blood Admin Direct Costs + Blood Admin Indirect Costs |
(Blood Administration Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 47, Column 1 * Worksheet PART 1, Row 47, Column 0 / Worksheet PART 1, Row 47, Column 27) + (Blood Administration Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 47, Column 1 * (1 - Worksheet PART 1, Row 47, Column 0 / Worksheet PART 1, Row 47, Column 27)) |
|
Operating Room |
Operating Room Direct Percentage Numerator |
|
Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0 |
|
Operating Room |
Operating Room Direct Percentage Denominator |
|
Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27 |
|
Operating Room |
Costs |
|
Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3 |
|
Operating Room |
Charges |
|
Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2 |
|
Operating Room |
Operating Room Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) |
|
Operating Room |
Operating Room Direct Cost for a Patient |
Operating Room Charges for a Patient * Operating Room Ratio * Operating Room Direct Cost Numerator / Operating Room Direct Cost Denominator |
(Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) * (Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27) |
|
Operating Room |
Operating Room Indirect Cost for a Patient |
Operating Room Charges for a Patient * Operating Room Ratio * (1 - Operating Room Direct Cost Numerator / Operating Room Direct Cost Denominator) |
(Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) *(1 -(Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27)) |
|
Operating Room |
Total Operating Room Costs |
Operating Room Direct Costs + Operating Room Indirect Costs |
((Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) * (Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27)) + (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) *(1 -(Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27)) |
|
Lithotripsy |
Lithotripsy Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) |
|
Lithotripsy |
Lithotripsy Direct Cost for a Patient |
Lithotripsy Charges for a Patient * Operating Room Ratio * Operating Room Direct Cost Numerator / Operating Room Direct Cost Denominator |
(Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) * (Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27) |
|
Lithotripsy |
Lithotripsy Indirect Cost for a Patient |
Lithotripsy Charges for a Patient * Operating Room Ratio * (1 - Operating Room Direct Cost Numerator / Operating Room Direct Cost Denominator) |
(Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) *(1 -(Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27)) |
|
Lithotripsy |
Total Lithotripsy Costs |
Lithotripsy Direct Costs + Lithotripsy Indirect Costs |
((Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) * (Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27)) + (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2) * ((Worksheet D-4, Row 37, Column 3 + Worksheet D-4, Row 38, Column 3 + Worksheet D-4, Row 39, Column 3) / (Worksheet D-4, Row 37, Column 2 + Worksheet D-4, Row 38, Column 2 + Worksheet D-4, Row 39, Column 2)) *(1 -(Worksheet PART 1, Row 37, Column 0 + Worksheet PART 1, Row 38, Column 0 + Worksheet PART 1, Row 39, Column 0) / (Worksheet PART 1, Row 37, Column 27 + Worksheet PART 1, Row 38, Column 27 + Worksheet PART 1, Row 39, Column 27)) |
|
Cardiology |
Cardiology Direct Percentage Numerator |
|
Worksheet PART 1, Row 53, Column 0 |
|
Cardiology |
Cardiology Direct Percentage Denominator |
|
Worksheet PART 1, Row 53, Column 27 |
|
Cardiology |
Cardiology Cost-to-Charge Ratio |
Supplied on Cost Report as Cardiology Cost-to-Charges Ratio |
Worksheet D-4, Row 53, Column 1 |
|
Cardiology |
Cardiology Direct Cost for a Patient |
Cardiology Charges for a Patient * Cardiology Ratio * Cardiology Direct Cost Numerator / Cardiology Direct Cost Denominator |
Cardiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 53, Column 1 * Worksheet PART 1, Row 53, Column 0 / Worksheet PART 1, Row 53, Column 27 |
|
Cardiology |
Cardiology Indirect Cost for a Patient |
Cardiology Charges for a Patient * Cardiology Ratio * (1 - Cardiology Direct Cost Numerator / Cardiology Direct Cost Denominator) |
Cardiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 53, Column 1 *(1 - Worksheet PART 1, Row 53, Column 0 / Worksheet PART 1, Row 53, Column 27) |
|
Cardiology |
Total Cardiology Costs |
Cardiology Direct Costs + Cardiology Indirect Costs |
(Cardiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 53, Column 1 * Worksheet PART 1, Row 53, Column 0 / Worksheet PART 1, Row 53, Column 27) + Cardiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 53, Column 1 *(1 - Worksheet PART 1, Row 53, Column 0 / Worksheet PART 1, Row 53, Column 27) |
|
Anesthesiology |
Anesthesiology Direct Percentage Numerator |
|
Worksheet PART 1, Row 40, Column 0 |
|
Anesthesiology |
Anesthesiology Direct Percentage Denominator |
|
Worksheet PART 1, Row 40, Column 27 |
|
Anesthesiology |
Anesthesiology Cost-to-Charge Ratio |
Supplied on Cost Report as Anesthesiology Cost-to-Charges Ratio |
Worksheet D-4, Row 40, Column 1 |
|
Anesthesiology |
Anesthesiology Direct Cost for a Patient |
Anesthesiology Charges for a Patient * Anesthesiology Ratio * Anesthesiology Direct Cost Numerator / Anesthesiology Direct Cost Denominator |
Anesthesiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 40, Column 1 * Worksheet PART 1, Row 40, Column 0 / Worksheet PART 1, Row 40, Column 27 |
|
Anesthesiology |
Anesthesiology Indirect Cost for a Patient |
Anesthesiology Charges for a Patient * Anesthesiology Ratio * (1 - Anesthesiology Direct Cost Numerator / Anesthesiology Direct Cost Denominator) |
Anesthesiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 40, Column 1 * (1 - Worksheet PART 1, Row 40, Column 0 / Worksheet PART 1, Row 40, Column 27) |
|
Anesthesiology |
Total Anesthesiology Costs |
Anesthesiology Direct Costs + Anesthesiology Indirect Costs |
(Anesthesiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 40, Column 1 * Worksheet PART 1, Row 40, Column 0 / Worksheet PART 1, Row 40, Column 27) + (Anesthesiology Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 40, Column 1 * (1 - Worksheet PART 1, Row 40, Column 0 / Worksheet PART 1, Row 40, Column 27)) |
|
Laboratory |
Laboratory Direct Percentage Numerator |
|
Worksheet PART 1, Row 44, Column 0 + Worksheet PART 1, Row 45, Column 0 + Worksheet PART 1, Row 54, Column 0 |
|
Laboratory |
Laboratory Direct Percentage Denominator |
|
Worksheet PART 1, Row 44, Column 27 + Worksheet PART 1, Row 45, Column 27 + Worksheet PART 1, Row 54, Column 27 |
|
Laboratory |
Costs |
|
Worksheet D-4, Row 44, Column 3 + Worksheet D-4, Row 45, Column 3 + Worksheet D-4, Row 54, Column 3 |
|
Laboratory |
Charges |
|
Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2 |
|
Laboratory |
Laboratory Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 44, Column 3 + Worksheet D-4, Row 45, Column 3 + Worksheet D-4, Row 54, Column 3) / (Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2) |
|
Laboratory |
Laboratory Direct Cost for a Patient |
Laboratory Charges for a Patient * Laboratory Ratio * Laboratory Direct Cost Numerator / Laboratory Direct Cost Denominator |
(Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2) * ((Worksheet D-4, Row 44, Column 3 + Worksheet D-4, Row 45, Column 3 + Worksheet D-4, Row 54, Column 3) / (Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2)) * (Worksheet PART 1, Row 44, Column 0 + Worksheet PART 1, Row 45, Column 0 + Worksheet PART 1, Row 54, Column 0) / (Worksheet PART 1, Row 44, Column 27 + Worksheet PART 1, Row 45, Column 27 + Worksheet PART 1, Row 54, Column 27) |
|
Laboratory |
Laboratory Indirect Cost for a Patient |
Laboratory Charges for a Patient * Laboratory Ratio * (1 - Laboratory Direct Cost Numerator / Laboratory Direct Cost Denominator) |
(Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2) * ((Worksheet D-4, Row 44, Column 3 + Worksheet D-4, Row 45, Column 3 + Worksheet D-4, Row 54, Column 3) / (Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2)) * (1 - (Worksheet PART 1, Row 44, Column 0 + Worksheet PART 1, Row 45, Column 0 + Worksheet PART 1, Row 54, Column 0) / (Worksheet PART 1, Row 44, Column 27 + Worksheet PART 1, Row 45, Column 27 + Worksheet PART 1, Row 54, Column 27)) |
|
Laboratory |
Total Laboratory Costs |
Laboratory Direct Costs + Laboratory Indirect Costs |
((Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2) * ((Worksheet D-4, Row 44, Column 3 + Worksheet D-4, Row 45, Column 3 + Worksheet D-4, Row 54, Column 3) / (Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2)) * (Worksheet PART 1, Row 44, Column 0 + Worksheet PART 1, Row 45, Column 0 + Worksheet PART 1, Row 54, Column 0) / (Worksheet PART 1, Row 44, Column 27 + Worksheet PART 1, Row 45, Column 27 + Worksheet PART 1, Row 54, Column 27)) + ((Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2) * ((Worksheet D-4, Row 44, Column 3 + Worksheet D-4, Row 45, Column 3 + Worksheet D-4, Row 54, Column 3) / (Worksheet D-4, Row 44, Column 2 + Worksheet D-4, Row 45, Column 2 + Worksheet D-4, Row 54, Column 2)) * (1 - (Worksheet PART 1, Row 44, Column 0 + Worksheet PART 1, Row 45, Column 0 + Worksheet PART 1, Row 54, Column 0) / (Worksheet PART 1, Row 44, Column 27 + Worksheet PART 1, Row 45, Column 27 + Worksheet PART 1, Row 54, Column 27))) |
|
Radiology |
Radiology Direct Percentage Numerator |
|
Worksheet PART 1, Row 41, Column 0 + Worksheet PART 1, Row 42, Column 0 + Worksheet PART 1, Row 43, Column 0 |
|
Radiology |
Radiology Direct Percentage Denominator |
|
Worksheet PART 1, Row 41, Column 27 + Worksheet PART 1, Row 42, Column 27 + Worksheet PART 1, Row 43, Column 27 |
|
Radiology |
Costs |
|
Worksheet D-4, Row 41, Column 3 + Worksheet D-4, Row 42, Column 3 + Worksheet D-4, Row 43, Column 3 |
|
Radiology |
Charges |
|
Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2 |
|
Radiology |
Radiology Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 41, Column 3 + Worksheet D-4, Row 42, Column 3 + Worksheet D-4, Row 43, Column 3) / (Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2) |
|
Radiology |
Radiology Direct Cost for a Patient |
Radiology Charges for a Patient * Radiology Ratio * Radiology Direct Cost Numerator / Radiology Direct Cost Denominator |
(Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2) * ((Worksheet D-4, Row 41, Column 3 + Worksheet D-4, Row 42, Column 3 + Worksheet D-4, Row 43, Column 3) / (Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2)) * (Worksheet PART 1, Row 41, Column 0 + Worksheet PART 1, Row 42, Column 0 + Worksheet PART 1, Row 43, Column 0) / (Worksheet PART 1, Row 41, Column 27 + Worksheet PART 1, Row 42, Column 27 + Worksheet PART 1, Row 43, Column 27) |
|
Radiology |
Radiology Indirect Cost for a Patient |
Radiology Charges for a Patient * Radiology Ratio * (1 - Radiology Direct Cost Numerator / Radiology Direct Cost Denominator) |
(Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2) * ((Worksheet D-4, Row 41, Column 3 + Worksheet D-4, Row 42, Column 3 + Worksheet D-4, Row 43, Column 3) / (Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2)) * (1 - (Worksheet PART 1, Row 41, Column 0 + Worksheet PART 1, Row 42, Column 0 + Worksheet PART 1, Row 43, Column 0) / (Worksheet PART 1, Row 41, Column 27 + Worksheet PART 1, Row 42, Column 27 + Worksheet PART 1, Row 43, Column 27)) |
|
Radiology |
Total Radiology Costs |
Radiology Direct Costs + Radiology Indirect Costs |
((Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2) * ((Worksheet D-4, Row 41, Column 3 + Worksheet D-4, Row 42, Column 3 + Worksheet D-4, Row 43, Column 3) / (Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2)) * (Worksheet PART 1, Row 41, Column 0 + Worksheet PART 1, Row 42, Column 0 + Worksheet PART 1, Row 43, Column 0) / (Worksheet PART 1, Row 41, Column 27 + Worksheet PART 1, Row 42, Column 27 + Worksheet PART 1, Row 43, Column 27)) + ((Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2) * ((Worksheet D-4, Row 41, Column 3 + Worksheet D-4, Row 42, Column 3 + Worksheet D-4, Row 43, Column 3) / (Worksheet D-4, Row 41, Column 2 + Worksheet D-4, Row 42, Column 2 + Worksheet D-4, Row 43, Column 2)) * (1 - (Worksheet PART 1, Row 41, Column 0 + Worksheet PART 1, Row 42, Column 0 + Worksheet PART 1, Row 43, Column 0) / (Worksheet PART 1, Row 41, Column 27 + Worksheet PART 1, Row 42, Column 27 + Worksheet PART 1, Row 43, Column 27))) |
|
MRI |
MRI Direct Percentage Numerator |
|
Worksheet PART 1, Row 41, Column 0 |
|
MRI |
MRI Direct Percentage Denominator |
|
Worksheet PART 1, Row 41, Column 27 |
|
MRI |
MRI Cost-to-Charge Ratio |
Supplied on Cost Report as MRI Cost-to-Charges Ratio |
Worksheet D-4, Row 41, Column 1 |
|
MRI |
MRI Direct Cost for a Patient |
MRI Charges for a Patient * MRI Ratio * MRI Direct Cost Numerator / MRI Direct Cost Denominator |
MRI Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 41, Column 1 * Worksheet PART 1, Row 41, Column 0 / Worksheet PART 1, Row 41, Column 27 |
|
MRI |
MRI Indirect Cost for a Patient |
MRI Charges for a Patient * MRI Ratio * (1 - MRI Direct Cost Numerator / MRI Direct Cost Denominator) |
MRI Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 41, Column 1 * (1 - Worksheet PART 1, Row 41, Column 0 / Worksheet PART 1, Row 41, Column 27) |
|
MRI |
Total MRI Costs |
MRI Direct Costs + MRI Indirect Costs |
(MRI Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 41, Column 1 * Worksheet PART 1, Row 41, Column 0 / Worksheet PART 1, Row 41, Column 27) + (MRI Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 41, Column 1 * (1 - Worksheet PART 1, Row 41, Column 0 / Worksheet PART 1, Row 41, Column 27)) |
|
Outpatient Service* |
Outpatient Service Direct Percentage Numerator |
|
Worksheet PART 1, Row 63, Column 0 |
|
Outpatient Service* |
Outpatient Service Direct Percentage Denominator |
|
Worksheet PART 1, Row 63, Column 27 |
|
Outpatient Service* |
Outpatient Service Cost-to-Charge Ratio |
Supplied on Cost Report as Outpatient Service Cost-to-Charges Ratio |
Worksheet D-4, Row 63, Column 1 |
|
Outpatient Service* |
Outpatient Service Direct Cost for a Patient |
Outpatient Service Charges for a Patient * Outpatient Service Ratio * Outpatient Service Direct Cost Numerator / Outpatient Service Direct Cost Denominator |
Outpatient Service Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 63, Column 1 * Worksheet PART 1, Row 63, Column 0 / Worksheet PART 1, Row 63, Column 27 |
|
Outpatient Service* |
Outpatient Service Indirect Cost for a Patient |
Outpatient Service Charges for a Patient * Outpatient Service Ratio * (1 - Outpatient Service Direct Cost Numerator / Outpatient Service Direct Cost Denominator) |
Outpatient Service Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 63, Column 1 * (1 - Worksheet PART 1, Row 63, Column 0 / Worksheet PART 1, Row 63, Column 27) |
|
Outpatient Service* |
Total Outpatient Service Costs |
Outpatient Service Direct Costs + Outpatient Service Indirect Costs |
(Outpatient Service Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 63, Column 1 * Worksheet PART 1, Row 63, Column 0 / Worksheet PART 1, Row 63, Column 27) + (Outpatient Service Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 63, Column 1 * (1 - Worksheet PART 1, Row 63, Column 0 / Worksheet PART 1, Row 63, Column 27)) |
|
ER |
ER Direct Percentage Numerator |
|
Worksheet PART 1, Row 61, Column 0 |
|
ER |
ER Direct Percentage Denominator |
|
Worksheet PART 1, Row 61, Column 27 |
|
ER |
ER Cost-to-Charge Ratio |
Supplied on Cost Report as ER Cost-to-Charges Ratio |
Worksheet D-4, Row 61, Column 1 |
|
ER |
ER Direct Cost for a Patient |
ER Charges for a Patient * ER Ratio * ER Direct Cost Numerator / ER Direct Cost Denominator |
ER Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 61, Column 1 * Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27 |
|
ER |
ER Indirect Cost for a Patient |
ER Charges for a Patient * ER Ratio * (1 - ER Direct Cost Numerator / ER Direct Cost Denominator) |
ER Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 61, Column 1 * (1 -Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27) |
|
ER |
Total ER Costs |
ER Direct Costs + ER Indirect Costs |
(ER Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 61, Column 1 * Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27) + (ER Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 61, Column 1 * (1 -Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27)) |
|
Ambulance* |
Ambulance Direct Percentage Numerator |
|
Worksheet PART 1, Row 61, Column 0 |
|
Ambulance* |
Ambulance Direct Percentage Denominator |
|
Worksheet PART 1, Row 61, Column 27 |
|
Ambulance* |
Ambulance Cost-to-Charge Ratio |
Supplied on Cost Report as Ambulance Cost-to-Charges Ratio |
Worksheet D-4, Row 65, Column 1 |
|
Ambulance* |
Ambulance Direct Cost for a Patient |
Ambulance Charges for a Patient * Ambulance Ratio * Ambulance Direct Cost Numerator / Ambulance Direct Cost Denominator |
Ambulance Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 65, Column 1 * Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27 |
|
Ambulance* |
Ambulance Indirect Cost for a Patient |
Ambulance Charges for a Patient * Ambulance Ratio * (1 - Ambulance Direct Cost Numerator / Ambulance Direct Cost Denominator) |
Ambulance Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 65, Column 1 * (1 -Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27) |
|
Ambulance* |
Total Ambulance Costs |
Ambulance Direct Costs + Ambulance Indirect Costs |
(Ambulance Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 65, Column 1 * Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27) + (Ambulance Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 65, Column 1 * (1 -Worksheet PART 1, Row 61, Column 0 / Worksheet PART 1, Row 61, Column 27)) |
|
Professional Fees |
Professional Fees Direct Percentage Numerator |
|
Worksheet PART 1, Row 103, Column 0 |
|
Professional Fees |
Professional Fees Direct Percentage Denominator |
|
Worksheet PART 1, Row 103, Column 27 |
|
Professional Fees |
Costs |
|
Worksheet D-4, Row 101, Column 3 |
|
Professional Fees |
Charges |
|
Worksheet D-4, Row 101, Column 2 |
|
Professional Fees |
Professional Fees Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 101, Column 3) / (Worksheet D-4, Row 101, Column 4) |
|
Professional Fees |
Professional Fees Direct Cost for a Patient |
Professional Fees Charges for a Patient * Professional Fees Ratio * Professional Fees Direct Cost Numerator / Professional Fees Direct Cost Denominator |
Worksheet D-4, Row 101, Column 2 * ((Worksheet D-4, Row 101, Column 3) / (Worksheet D-4, Row 101, Column 4)) * Worksheet PART 1, Row 103, Column 0 / Worksheet PART 1, Row 103, Column 27 |
|
Professional Fees |
Professional Fees Indirect Cost for a Patient |
Professional Fees Charges for a Patient * Professional Fees Ratio * (1 - Professional Fees Direct Cost Numerator / Professional Fees Direct Cost Denominator) |
Worksheet D-4, Row 101, Column 2 * ((Worksheet D-4, Row 101, Column 3) / (Worksheet D-4, Row 101, Column 4)) * (1 - Worksheet PART 1, Row 103, Column 0 / Worksheet PART 1, Row 103, Column 27) |
|
Professional Fees |
Total Professional Fees Costs |
Professional Fees Direct Costs + Professional Fees Indirect Costs |
(Worksheet D-4, Row 101, Column 2 * ((Worksheet D-4, Row 101, Column 3) / (Worksheet D-4, Row 101, Column 4)) * Worksheet PART 1, Row 103, Column 0 / Worksheet PART 1, Row 103, Column 27) + (Worksheet D-4, Row 101, Column 2 * ((Worksheet D-4, Row 101, Column 3) / (Worksheet D-4, Row 101, Column 4)) * (1 - Worksheet PART 1, Row 103, Column 0 / Worksheet PART 1, Row 103, Column 27)) |
|
Organ Acquisition Costs RCC* |
Organ Acquisition Direct Percentage Numerator |
|
Worksheet PART 1, Row 82, Column 0 + Worksheet PART 1, Row 83, Column 0 + Worksheet PART 1, Row 84, Column 0 + Worksheet PART 1, Row 85, Column 0 + Worksheet PART 1, Row 86, Column 0 |
|
Organ Acquisition Costs RCC* |
Organ Acquisition Direct Percentage Denominator |
|
Worksheet PART 1, Row 82, Column 27 + Worksheet PART 1, Row 83, Column 27 + Worksheet PART 1, Row 84, Column 27 + Worksheet PART 1, Row 85, Column 27 + Worksheet PART 1, Row 86, Column 27 |
|
Organ Acquisition Costs RCC* |
Costs |
|
Worksheet D-Parts III and IV, Row 53, Column 1 |
|
Organ Acquisition Costs RCC* |
Charges |
|
Worksheet D-Parts III and IV, Row 53, Column 3 |
|
Organ Acquisition Costs RCC* |
Organ Acquisition Costs Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-3, Row 53, Column 1 + Worksheet D-4, Row 53, Column 1) / (Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3) |
|
Organ Acquisition Costs RCC* |
Organ Acquisition Direct Cost for a Patient |
Organ Acquisition Charges for a Patient * Organ Acquisition Ratio * Organ Acquisition Direct Cost Numerator / Organ Acquisition Direct Cost Denominator |
(Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3) * ((Worksheet D-3, Row 53, Column 1 + Worksheet D-4, Row 53, Column 1) / (Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3)) * (Worksheet PART 1, Row 82, Column 0 + Worksheet PART 1, Row 83, Column 0 + Worksheet PART 1, Row 84, Column 0 + Worksheet PART 1, Row 85, Column 0 + Worksheet PART 1, Row 86, Column 0) / (Worksheet PART 1, Row 82, Column 27 + Worksheet PART 1, Row 83, Column 27 + Worksheet PART 1, Row 84, Column 27 + Worksheet PART 1, Row 85, Column 27 + Worksheet PART 1, Row 86, Column 27) |
|
Organ Acquisition Costs RCC* |
Organ Acquisition Indirect Cost for a Patient |
Organ Acquisition Charges for a Patient * Organ Acquisition Ratio * (1 - Organ Acquisition Direct Cost Numerator / Organ Acquisition Direct Cost Denominator) |
(Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3) * ((Worksheet D-3, Row 53, Column 1 + Worksheet D-4, Row 53, Column 1) / (Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3)) * (1 - (Worksheet PART 1, Row 82, Column 0 + Worksheet PART 1, Row 83, Column 0 + Worksheet PART 1, Row 84, Column 0 + Worksheet PART 1, Row 85, Column 0 + Worksheet PART 1, Row 86, Column 0) / (Worksheet PART 1, Row 82, Column 27 + Worksheet PART 1, Row 83, Column 27 + Worksheet PART 1, Row 84, Column 27 + Worksheet PART 1, Row 85, Column 27 + Worksheet PART 1, Row 86, Column 27)) |
|
Organ Acquisition Costs RCC* |
Total Organ Acquisition Costs |
Organ Acquisition Direct Costs + Organ Acquisition Indirect Costs |
((Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3) * ((Worksheet D-3, Row 53, Column 1 + Worksheet D-4, Row 53, Column 1) / (Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3)) * (Worksheet PART 1, Row 82, Column 0 + Worksheet PART 1, Row 83, Column 0 + Worksheet PART 1, Row 84, Column 0 + Worksheet PART 1, Row 85, Column 0 + Worksheet PART 1, Row 86, Column 0) / (Worksheet PART 1, Row 82, Column 27 + Worksheet PART 1, Row 83, Column 27 + Worksheet PART 1, Row 84, Column 27 + Worksheet PART 1, Row 85, Column 27 + Worksheet PART 1, Row 86, Column 27)) + (Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3) * ((Worksheet D-3, Row 53, Column 1 + Worksheet D-4, Row 53, Column 1) / (Worksheet D-3, Row 53, Column 3 + Worksheet D-4, Row 53, Column 3)) * (1 - (Worksheet PART 1, Row 82, Column 0 + Worksheet PART 1, Row 83, Column 0 + Worksheet PART 1, Row 84, Column 0 + Worksheet PART 1, Row 85, Column 0 + Worksheet PART 1, Row 86, Column 0) / (Worksheet PART 1, Row 82, Column 27 + Worksheet PART 1, Row 83, Column 27 + Worksheet PART 1, Row 84, Column 27 + Worksheet PART 1, Row 85, Column 27 + Worksheet PART 1, Row 86, Column 27)) |
|
ESRD* |
ERSD Direct Percentage Numerator |
|
Worksheet PART 1, Row 67, Column 0 + Worksheet PART 1, Row 64, Column 0 |
|
ESRD* |
ERSD Direct Percentage Denominator |
|
Worksheet PART 1, Row 67, Column 27 + Worksheet PART 1, Row 64, Column 27 |
|
ESRD* |
Costs |
|
Worksheet D-4, Row 67, Column 3 + Worksheet D-4, Row 64, Column 3 |
|
ESRD* |
Charges |
|
Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2 |
|
ESRD* |
ESRD Cost-to-Charge Ratio |
Sum of Costs / Sum of Charges |
(Worksheet D-4, Row 67, Column 3 + Worksheet D-4, Row 64, Column 3) / (Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2) |
|
ESRD* |
ERSD Direct Cost for a Patient |
ERSD Charges for a Patient * ERSD Ratio * ERSD Direct Cost Numerator / ERSD Direct Cost Denominator |
(Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2) * ((Worksheet D-4, Row 67, Column 3 + Worksheet D-4, Row 64, Column 3) / (Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2)) * (Worksheet PART 1, Row 67, Column 0 + Worksheet PART 1, Row 64, Column 0) / (Worksheet PART 1, Row 67, Column 27 + Worksheet PART 1, Row 64, Column 27) |
|
ESRD* |
ERSD Indirect Cost for a Patient |
ERSD Charges for a Patient * ERSD Ratio * (1 - ERSD Direct Cost Numerator / ERSD Direct Cost Denominator) |
(Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2) * ((Worksheet D-4, Row 67, Column 3 + Worksheet D-4, Row 64, Column 3) / (Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2)) * (1 - (Worksheet PART 1, Row 67, Column 0 + Worksheet PART 1, Row 64, Column 0) / (Worksheet PART 1, Row 67, Column 27 + Worksheet PART 1, Row 64, Column 27)) |
|
ESRD* |
Total ERSD Costs |
ERSD Direct Costs + ERSD Indirect Costs |
((Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2) * ((Worksheet D-4, Row 67, Column 3 + Worksheet D-4, Row 64, Column 3) / (Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2)) * (Worksheet PART 1, Row 67, Column 0 + Worksheet PART 1, Row 64, Column 0) / (Worksheet PART 1, Row 67, Column 27 + Worksheet PART 1, Row 64, Column 27)) + (Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2) * ((Worksheet D-4, Row 67, Column 3 + Worksheet D-4, Row 64, Column 3) / (Worksheet D-4, Row 67, Column 2 + Worksheet D-4, Row 64, Column 2)) * (1 - (Worksheet PART 1, Row 67, Column 0 + Worksheet PART 1, Row 64, Column 0) / (Worksheet PART 1, Row 67, Column 27 + Worksheet PART 1, Row 64, Column 27)) |
|
Clinic |
Clinic Direct Percentage Numerator |
|
Worksheet PART 1, Row 60, Column 0 |
|
Clinic |
Clinic Direct Percentage Denominator |
|
Worksheet PART 1, Row 60, Column 27 |
|
Clinic |
Clinic Cost-to-Charge Ratio |
Supplied on Cost Report as Clinic Cost-to-Charges Ratio |
Worksheet D-4, Row 60, Column 1 |
|
Clinic |
Clinic Direct Cost for a Patient |
Clinic Charges for a Patient * Clinic Ratio * Clinic Direct Cost Numerator / Clinic Direct Cost Denominator |
Clinic Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 60, Column 1 * Worksheet PART 1, Row 60, Column 0 / Worksheet PART 1, Row 60, Column 27 |
|
Clinic |
Clinic Indirect Cost for a Patient |
Clinic Charges for a Patient * Clinic Ratio * (1 - Clinic Direct Cost Numerator / Clinic Direct Cost Denominator) |
Clinic Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 60, Column 1 * (1 - Worksheet PART 1, Row 60, Column 0 / Worksheet PART 1, Row 60, Column 27) |
|
Clinic |
Total Clinic Costs |
Clinic Direct Costs + Clinic Indirect Costs |
(Clinic Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 60, Column 1 * Worksheet PART 1, Row 60, Column 0 / Worksheet PART 1, Row 60, Column 27) + (Clinic Charges for a Patient from Submitted Data (MedPAR) * Worksheet D-4, Row 60, Column 1 * (1 - Worksheet PART 1, Row 60, Column 0 / Worksheet PART 1, Row 60, Column 27)) |
|
Direct Costs |
Direct Costs for a Patient |
|
Sum of the Direct Costs for the Following for the Patient: Private Room + Semi Private Room + Ward + Intensive Care + Coronary Care + Other + Pharmacy + Med Surg Supplies + DME + Used DME + Physical Therapy + Occupational Therapy + Speech Therapy + Inhalation Therapy + Blood + Blood Admin + Operating Room + Lithotripsy + Cardiology + Anesthesiology + Laboratory + Radiology + MRI + Outpatient Service + ER + Ambulance + Professional Fee + Organ Acquisition + ESRD + Clinic |
|
Indirect Costs |
Indirect Costs for a Patient |
|
Sum of the Indirect Costs for the Following for the Patient: Private Room + Semi Private Room + Ward + Intensive Care + Coronary Care + Other + Pharmacy + Med Surg Supplies + DME + Used DME + Physical Therapy + Occupational Therapy + Speech Therapy + Inhalation Therapy + Blood + Blood Admin + Operating Room + Lithotripsy + Cardiology + Anesthesiology + Laboratory + Radiology + MRI + Outpatient Service + ER + Ambulance + Professional Fee + Organ Acquisition + ESRD + Clinic |
|
Total Costs |
Total Costs for a Patient |
|
Sum of Direct Costs plus Sum of Indirect Costs |
