Outpatient Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE OF CONTENTS

	Topic	Page(s)
T able 1:	Record Specifications	18-503 - 18-509
T able 2:	Worksheet Indicators	18-510 - 18-511
T able 3:	List of Data Elements With Worksheet, Line, and Column Designations	18-511 - 18-520
T able 3A:	Worksheets Requiring No Input	18-521
T able 3B:	Tables to Worksheet S-2	18-521
T able 3C:	Lines That Cannot Be Subscripted	18-521
T able 4:	Reserved for future use
T able 5:	Cost Center Coding	18-522 - 18-525
T able 6:	Edits:
	Level I Edits	18-526 - 18-528
	Level II Edits	18-529 - 18-531

Rev. 7 18-501

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 1 - RECORD SPECIFICATIONS

T able 1 specifies the standard record format to be used for electronic cost reporting. Each electronic cost report submission (file) has three types of records. The first group (type one records) contains information for identifying, processing, and resolving problems. The text used throughout the cost report for variable line labels (e.g., Worksheet A) and variable column headers (Worksheet B‑1) is included in the type two records. Refer to Table 5 for cost center coding. The data detailed in Table 3 are identified as type three records. The encryption coding at the end of the file, records 1, 1.01, and 1.02, are type 4 records.

T he medium for transferring cost reports submitted electronically to fiscal intermediaries is 3½" diskette. These disks must be in IBM format. The character set must be ASCII. You must seek approval from your fiscal intermediary regarding alternate methods of submission to ensure that the method of transmission is acceptable.

T he following are requirements for all records:

1 . All alpha characters must be in upper case.

2 . For micro systems, the end of record indicator must be a carriage return and line feed, in that sequence.

3 . No record may exceed 60 characters.

B elow is an example of a set of type 1 records with a narrative description of their meaning.

 1  2  3 4 5  6

1 23456789012345678901234567890123456789012345678901234567890

1 1 144600200400120043662A99P00120050312004366

R ecord #1: This is a cost report file submitted by Provider 144600 for the period from January 1, 2004 (2004001) through December 31, 2004 (2004366). It is filed on FORM CMS-2088-92. It is prepared with vendor number A99's PC based system, version number 1. Position 38 changes with each new test case and/or approval and is alpha. Positions 39 and 40 remain constant for approvals issued after the first test case. This file is prepared by the community mental health center on January 31, 2005 (2005031). The electronic cost report specification dated December 31, 2004 (2004366) is used to prepare this file.

F ILE NAMING CONVENTION

N ame each cost report file in the following manner:

C MNNNNNN.YYL, where

1 . CM (Community Mental Health Center Electronic Cost Report) is constant;

2 . NNNNNN is the 6 digit Medicare community mental health center provider number;

3 . YY is the year in which the provider's cost reporting period ends; and

4 . L is a character variable (A‑Z) to enable separate identification of files from community mental health centers with two or more cost reporting periods ending in the same calendar year.

Rev. 7 18-503

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 1 - RECORD SPECIFICATIONS

R ECORD NAME: Type 1 Records ‑ Record Number 1

		Size	Usage	Loc.	Remarks
1 .	Record Type	1	X	1	Constant "1"
2 .	NPI	10	9	2-11	Numeric only
3 .	Spaces	1	X	12
4 .	Record Number	1	X	13	Constant "1"
5 .	Spaces	3	X	14-16
6 .	CM Provider Number	6	9	17-22	Field must have 6 numeric characters.
7 .	Fiscal Year Beginning Date	7	9	23-29	YYYYDDD - Julian date; first day covered by this cost report
8 .	Fiscal Year Ending Date	7	9	30-36	YYYYDDD - Julian date; last day covered by this cost report
9 .	MCR Version	1	9	37	Constant "2" (for FORM CMS-2088-92)
1 0.	Vendor Code	3	X	38-40	To be supplied upon approval. Refer to page 18-503.
1 1.	Vendor Equipment	1	X	41	P = PC; M = Main Frame
1 2.	Version Number	3	X	42-44	Version of extract software, e.g., 001=1st, 002=2nd, etc. or 101=1st, 102=2nd. The version number must be incremented by 1 with each recompile and release to client(s).
1 3.	Creation Date	7	9	45-51	YYYYDDD – Julian date; date on which the file was created (extracted from the cost report)
1 4.	ECR Spec. Date	7	9	52-58	YYYYDDD – Julian date; date of electronic cost report specifications used in producing each file. Valid for cost reporting periods ending on or after 2004366 (12/31/2004).

18-504 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 1 - RECORD SPECIFICATIONS

R ECORD NAME: Type 1 Records ‑ Record Numbers 2 - 99

		Size	Usage	Loc.	Remarks
1 .	Record Type	1	9	1	Constant "1"
2 .	Spaces	10	X	2-11
3 .	Record Number	2	9	12-13	#2-99 - Reserved for future use.
4 .	Spaces	7	X	14-20	Spaces (optional)
5 .	ID Information	40	X	21-60	Left justified to position 21.

R ECORD NAME: Type 2 Records for Labels

		Size	Usage	Loc.	Remarks
1 .	Record Type	1	9	1	Constant "2"
2 .	Wkst. Indicator	7	X	2-8	Alphanumeric. Refer to Table 2.
3 .	Spaces	2	X	9-10
4 .	Line Number	3	9	11-13	Numeric
5 .	Subline Number	2	9	14-15	Numeric
6 .	Column Number	3	X	16-18	Alphanumeric
7 .	Subcolumn Number	2	9	19-20	Numeric
8 .	Cost Center Code	4	9	21-24	Numeric. Refer to Table 5 for appropriate cost center codes.
9 .	Labels/Headings
	a. Line Labels	36	X	25-60	Alphanumeric, left justified
	b. Column Headings Statistical Basis & Code	10	X	21-30	Alphanumeric, left justified

T he type 2 records contain both the text that appears on the pre‑printed cost report and any labels added by the preparer. Of these, there are three groups: (1) Worksheet A cost center names (labels); (2) column headings for stepdown entries; and (3) other text appearing in various places throughout the cost report.

A Worksheet A cost center label must be furnished for every cost center with cost or charge data anywhere in the cost report. The line and subline numbers for each label must be the same as the line and subline numbers of the corresponding cost center on Worksheet A. The columns and subcolumn numbers are always set to zero.

Rev. 7 18-505

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 1 - RECORD SPECIFICATIONS

C olumn headings for the General Service cost centers on Worksheets B and B-1 are supplied once. They consist of one to three records. Each statistical basis shown on Worksheet B‑1 is also to be reported. The statistical basis consists of one or two records (lines 4-5). Statistical basis code is supplied only to Worksheet B‑1 columns and is recorded as line 6. The statistical code must agree with the statistical bases indicated on lines 4 and 5, i.e., code 1 = square footage, code 2 = dollar value, and code 3 = all others. Refer to Table 2 for the special worksheet identifier to be used with column headings and statistical basis and to Table 3 for line and column references.

T he following type 2 cost center descriptions are to be used for all Worksheet A standard cost center lines.

L ine 1 2 3 4 5 6 7 8 9 10 11 12 29 30 31 32 33 34 35 36 37 4 5 4 6 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 6 1 6 2 6 3 6 4

Description CAP REL COSTS-BLDG & FIXT CAP REL COSTS-MVBLE EQUIP EMPLOYEE BENEFITS ADMINISTRATIVE & GENERAL MAINTENANCE & REPAIRS OPERATION OF PLANT LAUNDRY & LINEN SERVICE HOUSEKEEPING CAFETERIA CENTRAL SERVICES & SUPPLY MEDICAL RECORDS & LIBRARY PRO ED & TRAINING (APPRVD) DRUGS & BIOLOGICALS OCCUPATIONAL THERAPY PSYCHIATRIC / PSYCHOLOGICAL SERVICES INDIVIDUAL THERAPY GROUP THERAPY INDIVIDUALIZED ACTIVITY THERAPIES FAMILY COUNSELING DIAGNOSTIC SERVICES PATIENT TRAINING & EDUCATION SHELTERED WORKSHOPS RECREATIONAL PROGRAMS RESIDENT DAY CAMPS PRE-SCHOOL PROGRAMS DIAGNOSTIC CLINICS HOME EMPLOYMENT PROGRAMS EQUIPMENT LOAN SERVICE PHYSICIANS’ PRIVATE OFFICES FUND RAISING COFFEE SHOPS & CANTEEN RESEARCH INVESTMENT PROPERTY ADVERTISING FRANCHISE FEES & OTHER ASSESSMENTS PRO ED & TRAINING (NOT APPRVD) MEALS & TRANSPORTATION ACTIVITY THERAPIES PSYCHOSOCIAL PROGRAMS VOCATIONAL TRAINING

18-506 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 1 - RECORD SPECIFICATIONS

T ype 2 records for Worksheet B-1, columns 1-5, for lines 1-12 are listed below. The numbers running vertical to line 1 descriptions are the general service cost center line designations.

LINE

	__1______	2_____	3_____	4______	5____	6
1 2 3 4 5 6 7 8 9 1 0 1 1 1 2	CAP REL CAP REL EMPLOYEE ADMINIS- MAIN- OPERATION LAUNDRY HOUSE- CAFETERIA CENTRAL MEDICAL PROF. EDUC.	BLDGS & MOVABLE BENEFITS TRATIVE & TENANCE & OF PLANT & LINEN KEEPING SERVICES & RECORDS & & TRAINING	FIXTURES EQUIPMENT GENERAL REPAIRS SERVICES SUPPLY LIBRARY	SQUARE SQUARE GROSS ACCUM SQUARE SQUARE POUNDS OF HOURS OF MEALS COSTED TIME ASSIGNED	FEET FEET SALARIES COST FEET FEET LAUNDRY SERVICE SERVED REQUSTNS SPENT TIME	1 1 3 3 1 1 3 3 3 3 3 3

E xamples of type 2 records are below. Either zeros or spaces may be used in the line, subline, column, and subcolumn number fields (positions 11‑20). However, spaces are preferred. (See the first two lines of the example for a comparison.)* Refer to Table 5 and 6 for additional cost center code requirements.

E xamples:

W orksheet A line labels with embedded cost center codes:

* 2A000000 1 0100CAP REL COSTS-BLDG & FIXT

* 2A0000000000101000000101CAP REL COSTS-BLDG & FIXT‑‑WEST WING

2 A000000 2 0200CAP REL COSTS-MVBLE EQUIP

2 A000000 8 0800HOUSEKEEPING

2 A000000 30 3000OCCUPATIONAL THERAPY

2 A000000 49 4900DIAGNOSTIC CLINICS

2 A000000 49 1 4901DIAGNOSTIC CLINICS--OTHER

E xamples of column headings for Worksheets B‑1 and B; statistical bases used in cost allocation on Worksheet B-1; and statistical codes used for Worksheet B‑1 (line 6) are displayed below.

2 B10000* 1 1 CAP REL

2 B10000* 2 1 BLDGS &

2 B10000* 3 1 FIXTURES

2 B10000* 4 1 SQUARE

2 B10000* 5 1 FEET

2 B10000* 6 1 1

2 B10000* 1 3 EMPLOYEE

2 B10000* 2 3 BENEFITS

2 B10000* 4 3 GROSS

2 B10000* 5 3 SALARIES

2 B10000* 6 3 3

Rev. 7 18-507

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 1 - RECORD SPECIFICATIONS

R ECORD NAME: Type 3 Records for Nonlabel Data

		Size	Usage	Loc.	Remarks
1 .	Record Type	1	9	1	Constant "3"
2 .	Wkst. Indicator	7	X	2-8	Alphanumeric. Refer to Table 2.
3.	Spaces	2	X	9-10
4 .	Line Number	3	9	11-13	Numeric
5 .	Subline Number	2	9	14-15	Numeric
6 .	Column Number	3	X	16-18	Alphanumeric
7 .	Subcolumn Number	2	9	19-20	Numeric
8 .	Field Data
	a. Alpha Data	36	X	21-56	Left justified. (Y or N for yes/no answers; dates must use MM/DD/YYYY format - slashes, no hyphens.) Refer to Table 6 for additional requirements for alpha data.
		4	X	57-60	Spaces (optional).
	b. Numeric Data	16	9	21-36	Right justified. May contain embedded decimal point. Leading zeros are suppressed; trailing zeros to the right of the decimal point are not. Positive values are presumed; no “+” signs are allowed. Use leading minus to specify negative values. Express percentages as decimal equivalents, i.e., 8.75% is expressed as .087500. All records with zero values are dropped. Refer to Table 6 for additional requirements regarding numeric data.

A sample of type 3 records are below.

3 A000000 33 1 36393

3 A000000 33 1 1 5599

3 A000000 3 1 47750

3 A000000 4 1 167922

18-508 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 1 - RECORD SPECIFICATIONS

T he line numbers are numeric. In several places throughout the cost report (see list below), the line numbers themselves are data. The placement of the line and subline numbers as data must be uniform.

W orksheet A-1, columns 3 and 6

W orksheet A-3, column 4

W orksheet A-3-1, Part B, column 1

E xamples of records (*) with a Worksheet A line number as data are below.

3 A100010 13 0 TO SPREAD INTEREST EXPENSE

3 A100010 13 1 G

* 3A100010 13 3 1.00

3 A100010 13 4 221409

* 3A100010 13 6 51.00

3 A100010 13 7 225321

3 A100010 14 0 BETWEEN CAPITAL‑RELATED COST

3 A100010 14 1 G

* 3A100010 14 3 4.00

3 A100010 14 4 3912

3 A100010 15 0 BUILDING & FIXTURES AND

3 A100010 16 0 ADMINISTRATIVE AND GENERAL

3 A300010 18 0 IRS PENALTY

3 A300010 18 1 B

3 A300010 18 2 -935

* 3A300010 18 4 4.00

3 A300010 19 1 0 MISC INCOME

3 A300010 19 1 1 A

3 A300010 19 1 2 ‑114525

* 3A300010 19 1 4 4.00

* 3A31000A 1 1 9.00

3 A31000A 3 1 KITCHEN

3 A31000A 4 1 3352

3 A31000A 5 1 1122

R ECORD NAME: Type 4 Records - File Encryption

T his type 4 record consists of 3 records: 1, 1.01, and 1.02. These records are created at the point in which the ECR file has been completed and saved to disk and insures the integrity of the file.

Rev. 7 18-509

1895(Cont)

FORM CMS-2088-92

12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 2 - WORKSHEET INDICATORS

T his table contains the worksheet indicators that are used for electronic cost reporting. A worksheet indicator is provided for only those worksheets for which data are to be provided.

T he worksheet indicator consists of seven digits in positions 2‑8 of the record identifier. The first two digits of the worksheet indicator (positions 2 and 3 of the record identifier) always show the worksheet. The third digit of the worksheet indicator (position 4 of the record identifier) is as part of the worksheet, e.g., A85. For Worksheets A-1 and A-8-2, if there is a need for extra lines on multiple worksheets, the fifth and sixth digits of the worksheet indicator (positions 6 and 7 of the record identifier) identify the page number. The seventh digit of the worksheet indicator (position 8 of the record identifier) represents the worksheet or worksheet part.

W orksheets That Apply to the CMHC Complex

	Worksheet	Worksheet Indicator
	S, Part I	S000001
	S, Part III	S000003
	S, Part IV	S000004
	S-1	S100000
	A	A000000
	A-1	A100010	(b)
	A-3	A300000
	A-3-1, Part A	A31000A
	A-3-1, Part B	A31000B
	A-3-1, Part C	A31000C
	A-8-2	A820010
	A-8-5	A850000	(a,c)
	B-1 (For use in column headings)	B10000*
	B	B000000
	B-1	B100000
	C	C000000
	D	D000000	(a)
	G	G000000

18-510 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 2 - WORKSHEET INDICATORS

F OOTNOTES:

( a) Worksheets With Multiple Parts Using Identical Worksheet Indicator

A lthough some worksheets have multiple parts, the lines are numbered sequentially. In these instances, the same worksheet identifier is used with all lines from this worksheet regardless of the worksheet part. This differs from the Table 3 presentation, which still identifies each worksheet and part as they appear on the printed cost report. This affects Worksheet A‑8‑5.

( b) Multiple Worksheets for Reclassifications and Adjustments Before Stepdown

T he fifth and sixth digits of the worksheet indicator (positions 6 and 7 of the record) are numeric from 01‑99 to accommodate reports with more lines on Worksheet A-1. For reports that do not need additional worksheets, the default is 01. For reports that do need additional worksheets, the first page is numbered 01. The number for each additional page of the worksheet is incremented by 1.

( c) Multiple Worksheets A-8-5

T his worksheet is used only for occupational therapy services furnished by outside suppliers. The fourth digit of the worksheet indicator (position 5 of the record) is an alpha character of O for occupational therapy services.

Rev. 7 18-511

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

T his table identifies those data elements necessary to calculate a home health agency cost report. It also identifies some figures from a completed cost report. These calculated fields (e.g., Worksheet B, column 6) are needed to verify the mathematical accuracy of the raw data elements and to isolate differences between the file submitted by the home health agency complex and the report produced by the fiscal intermediary. Where an adjustment is made, that record must be present in the electronic data file. For explanations of the adjustments required, refer to the cost report instructions.

T able 3 "Usage" column is used to specify the format of each data item as follows:

9 Numeric, greater than or equal to zero.

- 9 Numeric, may be either greater than, less than, or equal to zero.

9 (x).9(y) Numeric, greater than zero, with x or fewer significant digits to the left of the decimal point, a decimal point, and exactly y digits to the right of the decimal point.

X Character.

C onsistency in line numbering (and column numbering for general service cost centers) for each cost center is essential. The sequence of some cost centers does change among worksheets.

T able 3 refers to the data elements needed from a standard cost report. When a standard line is subscripted, the subscripted lines must be numbered sequentially with the first subline number displayed as "01" or " 1" (with a space preceding the 1) in field locations 14‑15. It is unacceptable to format in a series of 10, 20, or skip subline numbers (i.e., 01, 03), except for skipping subline numbers for prior year cost center(s) deleted in the current period or initially created cost center(s) no longer in existence after cost finding. Exceptions are specified in this manual. For Other (specify) lines, i.e., Worksheet settlement series, all subscripted lines should be in sequence and consecutively numbered beginning with subscripted line number 01. Automated systems should reorder these numbers where providers skip or delete a line in the series.

D rop all records with zero values from the file. Any record absent from a file is treated as if it were zero.

A ll numeric values are presumed positive. Leading minus signs may only appear in data with values less than zero that are specified in Table 3 with a usage of "-9". Amounts that are within preprinted parentheses on the worksheets, indicating the reduction of another number, are reported as positive values.

18-512 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

W ORKSHEET S

P art I:
Name	1	1	36	X
Street	1.01	1	36	X
P.O. Box	1.01	2	9	X
City	1.02	1	36	X
State	1.02	2	2	X
Zip Code	1.02	3	10	X
Cost reporting period beginning date	1.03	1	10	X
Cost reporting period ending date	1.03	2	10	X
P rovider number (xxxxxx)	2	1	6	X
Type of control (See Table 3B.)	2	2	2	9
Type of control “other” (See Table 3B.)	2	3	36	X
Type of provider (see instructions)	2	4	2	9
Date certified (MM/DD/YYYY)	2	5	10	X
L ist amounts of malpractice premiums and paid losses:
Premiums:	3.01	1	9	9
Paid losses:	3.02	1	9	9
Self insurance	3.03	1	9	9
A re malpractice premiums and paid losses reported in other than the administrative and general cost center? (Y/N)	4	1	1	X
P art III:
B alances due provider or program:
T itle XVIII, Part B	6	1	9	-9
P art IV:
N umber of visits by discipline:
Title XVIII patients	14-23	1	9	9
Other Than Title XVIII patients	14-23	2	9	9
Total visits by discipline	14-23	3	9	9

Rev. 7 18-513

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

W ORKSHEET S (Continued)

P atient count by discipline:
Title XVIII	14-23	4	9	9
Other Than Title XVIII	14-23	5	9	9
In Total	14-23	6	9	9
F TE (full-time equivalent employees) on Payroll count by discipline:
Staff Therapists	14-23	7	9	9
Physicians	14-23	8	9	9
Social Workers	14-23	9	9	9
Others	14-23	10	9	9
U nduplicated census count:
Title XVIII	29	4	9	9(6).99
Other Than Title XVIII	29	5	9	9(6).99
In Total	29	6	9	9(6).99

S UPPLEMENTAL WORKSHEET S-1

T otal interim payments paid to provider	1	2	9	9
I nterim payments payable	2	2	9	9
D ate of each retroactive lump sum adjustment (MM/DD/YYYY)	3.01-3.98	1	10	X
A mount of each lump sum adjustment
Program to provider	3.01-3.49	2	9	9
Provider to program	3.50-3.98	2	9	9

18-514 Rev. 7

12-04 FORM CMS 2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

W ORKSHEET A

D irect salaries by department	3-14,29-38, 45-64	1	9	-9
Total direct salaries	65	1	9	9
O ther direct costs by department	1-14,29-38, 45-64	2	9	-9
T otal other direct costs	65	2	9	9
N et expenses for allocation by department	1-14,29-38, 45-64	7	9	-9
T otal expenses for allocation	65	7	9	9

W ORKSHEET A-1

F or each expense reclassification:
Explanation	1-29	0	36	X
Reclassification identification code	1-29	1	2	X
Increases:
Worksheet A line number	1-29	3	6	9(3).99
Reclassification amount	1-29	4	9	9
Decreases:
Worksheet A line number	1-29	6	6	9(3).99
Reclassification amount	1-29	7	9	9

W ORKSHEET A-3

D escription of adjustment	18, 19	0	36	X
B asis (A or B)	2,5-12,18, 19	1	1	X
A mount	1-12,18-21	2	9	-9
W orksheet A line number	1-4,8-12,18,19	4	6	9(3).99

Rev. 7 18-515

1895 (Cont.) FORM CMS 2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

S UPPLEMENTAL WORKSHEET A-3-1

P art A - Are there any related organization costs included on Worksheet A? (Y/N)	1	1	1	X
P art B - For costs incurred and adjustments required as a result of transactions with related organization(s):
Worksheet A line number	1-4	1	6	9(3).99
Amount included in Worksheet A	1-4	3	9	-9
Amount allowable in reimbursable cost	1-4	4	9	-9
P art C - For each related organization:
Type of interrelationship (A through G)	1-5	1	1	X
If type is G, specify description of relationship	1-5	0	36	X
Name of individual or partnership with interest in provider and related organization	1-5	2	36	X
Percent ownership of provider	1-5	3	6	9(3).99
Name of related organization	1-5	4	36	X
Percent ownership of related organization	1-5	5	6	9(3).99
Type of business	1-5	6	15	X

S UPPLEMENTAL WORKSHEET A-8-2

B y each cost center or physician:
Worksheet A line number	1-100	1	6	9(3).99
Physician identifier and aggregate only	1-100	2	36	X
Total physicians’ remuneration	1-100	3	9	9
Physicians’ remuneration – professional component	1-100	4	9	9

18-516 Rev. 7

12-04 FORM CMS 2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

S UPPLEMENTAL WORKSHEET A-8-2 (Continued)

Physicians’ remuneration – provider component	1-100	5	9	9
RCE amount	1-100	6	9	9
Number of physicians’ hours – provider component	1-100	7	9	9
Cost of membership and continuing education	1-100	12	9	9
Physician cost of malpractice insurance	1-100	14	9	9
I n total for the facility (sum of lines 1-100):
Total physicians’ remuneration	101	3	9	9
Physicians’ remuneration – professional component	101	4	9	9
Physicians’ remuneration – provider component	101	5	9	9
Number of physicians’ hours – provider component	101	7	9	9
Cost of membership and continuing education	101	12	9	9
Physician cost of malpractice insurance	101	14	9	9

Rev. 7 18-517

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

W ORKSHEETS B and B-1

C olumn heading (cost center name)	1-3 +	1-14	10	X
S tatistical basis	4, 5 +	1-14	10	X

+ Refer to Table 1 for specifications and Table 2 for the worksheet identifier for column headings. There may be up to five type 2 records (3 for cost center name and 2 for the statistical basis) for each column. However, for any column that has less than five type 2 record entries, blank records or the word blank is not required to maximize each column record count.

W ORKSHEET B

C osts after cost finding by department	29-38, 45-64	17	9	-9
T otal costs after cost finding	66	17	9	9

W ORKSHEET B-1

F or each cost allocation using accumulated costs as the statistic, include a record containing an X.	0	1-14	1	X
A ll cost allocation statistics	1-14,29-38,45-64	1-14 *	9	9
R econciliation	4-14,29-38,45-64	4A-14A	9	9

18-518 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

W ORKSHEET B-1 (Continued)

* In each column using accumulated costs as the statistical basis for allocating costs, identify each cost center that is to receive no allocation with a negative 1 (-1) placed in the accumulated cost column. Providers may elect to indicate total accumulated cost as a negative amount in the reconciliation column. However, there should never be entries in both the reconciliation column and accumulated column simultaneously. For those cost centers that are to receive partial allocation of costs, provide only the cost to be excluded from the statistic as a negative amount on the appropriate line in the reconciliation column. If line 4 is fragmented, line 4 must be deleted and subscripts of line 4 must be used.

W ORKSHEET C

P atient charges	29-38 (all on subline .02)	1	9	9
T otal patient costs	39.01	1	9	9
T otal patient charges	39.02	1	9	9
M edicare program charges	29-38 (all on subline .02)	3	9	9
T otal Medicare patient costs	39.01	3	9	9
T otal Medicare patient charges	39.02	3	9	9
N on-Medicare program charges	29-38 (all on subline .02)	4	9	9
T otal Non-Medicare program costs	39.01	4	9	9
T otal Non-Medicare program charges	39.02	4	9	9
M edicare charges for services rendered on or after 8/1/2000, 1/1/2002, 1/1/2003 or 1/1/2004	29-38	5	9	9
T otal Medicare program charges after transition date	39	5	9	9
M edicare cost for services rendered on or after 8/1/2000, 1/1/2002, 1/1/2003 or 1/1/2004	29-38	6	9	9
Total Medicare program costs after transition date	39	6	9	9

W ORKSHEET D

P art I: T otal PPS payments for CMHC – Part A and B	1.01	1 & 1.01	9	9
1 996 CMHC specific payment to cost ratio	1.02	1 & 1.01	5	9.9(3)
A mounts paid by primary payers when Medicare liability is secondary to the primary payer	2	1 & 1.01	9	9

Rev. 7 18-519

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 3 - LIST OF DATA ELEMENTS WITH WORKSHEET, LINE, AND COLUMN DESIGNATIONS

D ESCRIPTION	LINE(S)	COLUMN(S)	FIELD SIZE	USAGE

W ORKSHEET D (Continued)

D eductibles billed to Medicare patients	4	1	9	9
C oinsurance billed to Medicare patients	9	1	9	9
R eimbursable bad debts	11	1	9	9
R eimbursable bad debts	11.01	1	9	9
S equestration adjustment (see instructions)	16	1	9	9
T ext as needed for blank line (specify)	16.5	0	36	X
O ther adjustments (see instructions)	16.5	1	9	-9

W ORKSHEET G

T otal patient revenues	1	2	9		9
C ontractual allowances and discounts on patients’ accounts	2	2	9		-9
O ther income	6-22	1	9	9
O ther expenses	25-30	1	9	9
N et income	32	2	9	-9
T ext as needed for blank lines	20-22, 28-30	0	36	X

18-520 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

T ABLE 3A ‑ WORKSHEETS REQUIRING NO INPUT

Worksheet S, Part II

Worksheet A‑8‑5, Part II

T ABLE 3B ‑ TABLES TO WORKSHEET S, Part I

T ype of Control Type of Provider

1 = Voluntary Nonprofit, Church 5 = Community Mental Health Center

2 = Voluntary Nonprofit, Other (CMHC)

3 = Proprietary, Sole Proprietor

4 = Proprietary, Corporation

5 = Proprietary, Partnership

6 = Proprietary, Other

7 = Governmental, State

8 = Governmental, Hospital District

9 = Governmental, County

1 0 = Governmental, City

1 1 = Governmental, City‑County

1 2 = Governmental, Other

T ABLE 3C ‑ LINES THAT CANNOT BE SUBSCRIPTED

( BEYOND THOSE PREPRINTED)

	Worksheet	Lines
	S, Parts I - III	All
	S, Part IV	28, 29
	Supplemental S-1	1, 2, 3.01-3.04, 3.50-3.53
	A	65 (Lines 28, 39, 44 may not be used)
	A-1	All
	A-3	1-12, 13-17, 17.1, 17.2, 17.3, 22
	Supplemental A-3-1, Part B	1-3
	Supplemental A-3-1, Part C	1-4
	B	65, 66 (Lines 28, 39, 44 may not be used)
	B-1	65-67 (Lines 28, 39, 44 may not be used)
	C	28, 39, 44
	D	All (except line 16.5)*
	G	All (except lines 22 and 30)
	A-8-5	All

* NOTE: Line 16.5 may be subscripted 4 times from line 16.6 through 16.9.

Rev. 7 18-521

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 5 - COST CENTER CODING

I NSTRUCTIONS FOR PROGRAMMERS

C ost center coding is required because there are thousands of unique cost center names in use by providers. Many of these names are peculiar to the reporting provider and give no hint as to the actual function being reported. Using codes to standardize meanings makes practical data analysis possible. The method to accomplish this must be rigidly controlled to assure accuracy.

F or any added cost center names (the preprinted cost center labels must be precoded), preparers must be presented with the allowable choices for that line or range of lines from the lists of standard and nonstandard descriptions. They then select a description that best matches their added label. The code associated with the matching description, including increments due to choosing the same description more than once, will then be appended to the user’s label by the software.

A dditional guidelines are:

• D o not allow any pre-existing codes for the line to be carried over.

• D o not precode all Other lines.

• F or cost centers, the order of choice must be standard first, then specific nonstandard, and finally the nonstandard A Other . . ."

• F or the nonstandard "Other . . .", prompt the preparers with, “Is this the most appropriate choice?," and then offer the chance to answer yes or to select another description.

• A llow the preparers to invoke the cost center coding process again to make corrections.

• F or the preparers’ review, provide a separate printed list showing their added cost center names on the left with the chosen standard or nonstandard descriptions and codes on the right.

• O n the screen next to the description, display the number of times the description can be selected on a given report, decreasing this number with each usage to show how many remain. The numbers are shown on the cost center tables.

• D o not change standard cost center lines, descriptions and codes. The acceptable formats for these items are listed on page 18-535 of the Standard Cost Center Descriptions and Codes. The proper line number is the first two digits of the cost center code.

I NSTRUCTIONS FOR PREPARERS

C oding of Cost Center Labels

C ost center coding standardized the meaning of cost center labels used by health care providers on the Medicare cost reporting forms. The use of this coding methodology allows providers to continue to use their labels for cost centers that have meaning within the individual institution.

T he four digit codes that are required to be associated with each label provide standardized meaning for data analysis. Normally, it is necessary to code only added labels because the preprinted standard labels are automatically coded by CMS approved cost report software.

A dditional cost center descriptions have been identified. These additional descriptions are hereafter referred to as the nonstandard labels. Included with the nonstandard descriptions is an "Other . . ." designation to provide for situations where no match in meaning can be found. Refer to Worksheet A, line 38.

18-522 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 5 - COST CENTER CODING

B oth the standard and nonstandard cost center descriptions along with their cost center codes are shown on Table 5. The "use" column on that table indicates the number of times that a given code can be used on one cost report. You are required to compare your added label to the descriptions shown on the standard and nonstandard tables for purposes of selecting a code. Most CMS approved software provides an automated process to present you with the allowable choices for the line/column being coded and automatically associates the code for the selected matching description with your label.

A dditional Guidelines

C ategories

M ake a selection from the proper category such as general service description for general service lines, special purpose cost center descriptions for special purpose cost center lines, etc.

U se of a Cost Center Coding Description More Than Once

O ften a description from the "standard" or "nonstandard" tables applies to more than one of the labels being added or changed by the preparer. In the past, it was necessary to determine which code was to be used and then increment the code number upwards by one for each subsequent use. This was done to provide a unique code for each cost center label. Now, most approved software associate the proper code, including increments as required, once a matching description is selected. Remember to use your label. You are matching to CMS’s description only for coding purposes.

C ost Center Coding and Line Restrictions

U se cost center codes only in designated lines in accordance with the classification of cost center(s), e.g., lines 29 through 37 may only contain cost center codes within the CMHC services cost center category of both standard and nonstandard coding.

A dministrative and General Cost Centers

A &G can either be shown as one cost center with a code of 0400 or subscripted If A&G is subscripted, do not use line 4 or cost center code 0400.

Rev. 7 18-523

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 5 - COST CENTER CODING

S TANDARD COST CENTER DESCRIPTIONS AND CODES

	CODE	USE
G ENERAL SERVICE COST CENTERS
C apital Related - Buildings and Fixtures	0100	(20)
C apital Related - Movable Equipment	0200	(20)
E mployee Benefits	0300	(20)
A dministrative and General	0400	(20)
M aintenance and Repairs	0500	(20)
O peration of Plant	0600	(20)
L aundry and Linen Services	0700	(20)
H ousekeeping	0800	(20)
C afeteria	0900	(20)
C entral Services and Supply	1000	(20)
M edical Records and Library	1100	(20)
P rofession Education and Training	1200	(20)
C MHC
D rugs and Biologicals	2900	(10)
O ccupational Therapy	3000	(10)
P sychiatric/Psychological Services	3100	(10)
I ndividual Therapy	3200	(10)
G roup Therapy	3300	(10)
I ndividualized Activities Therapy	3400	(10)
F amily Counseling	3500	(10)
D iagnostic Services	3600	(10)
P atient Training & Education	3700	(10)
N ONREIMBURSABLE COST SERVICES
S heltered Workshops	4500	(10)
Recreational Programs	4600	(10)

18-524 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS 2088-92

TABLE 5 - COST CENTER CODING

S TANDARD COST CENTER DESCRIPTIONS AND CODES (CONTINUED)

	CODE	USE
N ONREIMBURSABLE SERVICES (Continued)
R esident Day Camps	4700	(10)
P re-school Programs	4800	(10)
D iagnostic Clinics	4900	(10)
H ome Employment Programs	5000	(10)
E quipment Loan Service	5100	(10)
P hysician’s Private Office	5200	(10)
F und Raising	5300	(10)
C offee shops and Canteen	5400	(10)
R esearch	5500	(10)
I nvestment Property	5600	(10)
A dvertising	5700	(10)
F ranchise Fees and Other Assessments	5800	(10)
P rofession Education Training	5900	(10)
	CODE	USE
C MHC NONREIMBURSABLE SERVICES
M eals and Transportation	6100	(10)
A ctivity Therapies	6200	(10)
P sychosocial Programs	6300	(10)
V ocational Training	6400	(10)

N ONSTANDARD COST CENTER DESCRIPTIONS AND CODES

S PECIAL PURPOSE COST CENTER
O ther General Services Cost Centers	1300	(10)
O ther General Services Cost Centers	1400	(10)
O ther CMHC Services	3800	(10)
O ther Nonreimbursable Cost Centers	6000	(10)

Rev. 7 18-525

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 6 - EDITS

M edicare cost reports submitted electronically must be subjected to various edits, which are divided into two categories: Level I and level II edits. These include mathematical accuracy edits, certain minimum file requirements, and other data edits. Any vendor software that produces an electronic cost report file for Medicare home health agencies must automate all of these edits. Failure to properly implement these edits may result in the suspension of a vendor's system certification until corrective action is taken. The vendor’s software should provide meaningful error messages to notify the home health agency of the cause of every exception. The edit message generated by the vendor systems must contain the related 4 digit and 1 alpha character, where indicated, reject/edit code specified below. Any file containing a level I edit will be rejected by your fiscal intermediary without exception.

L evel I edits (1000 series reject codes) test that the file conforms to processing specifications, identifying error conditions that would result in a cost report rejection. These edits also test for the presence of some critical data elements specified in Table 3. Level II edits (2000 series edit codes) identify potential inconsistencies and/or missing data items that may have exceptions and should not automatically cause a cost report rejection. Resolve these items and submit appropriate worksheets and/or data supporting the exceptions with the cost report. Failure to submit the appropriate data with your cost report may result in payments being withheld pending resolution of the issue(s).

T he vendor requirements (above) and the edits (below) reduce both intermediary processing time and unnecessary rejections. Vendors should develop their programs to prevent their client community mental health centers from generating either a hard copy substitute cost report or electronic cost report file where level I edits exist. Ample warnings should be given to the provider where level II edit conditions are violated.

N OTE: Dates in brackets [ ] at the end of an edit indicate the effective date of that edit for cost reporting periods ending on or after that date. Dates followed by a “b” are for cost reporting periods beginning on or after the specified date. Dates followed by an “s” are for services rendered on or after the specified date unless otherwise noted. [10/31/2000]

I . Level I Edits (Minimum File Requirements)

R eject Code	Condition
1 000	The first digit of every record must be either 1, 2, 3, or 4 (encryption code only). [12/31/2004]
1 005	No record may exceed 60 characters. [12/31/2004]
1 010	All alpha characters must be in upper case. This is exclusive of the encryption code, type 4 record, record numbers 1, 1.01, and 1.02. [12/31/2004]
1 015	For micro systems, the end of record indicator must be a carriage return and line feed, in that sequence. [12/31/2004]
1 020	The CMHC provider number (record #1, positions 17-22) must be valid (issued by the applicable certifying agency and falls within the specified range) and numeric. [12/31/2004]
1 025	All dates (record #1, positions 23-29, 30-36, 45-51, and 52-58) must be in Julian format and legitimate (the date must be possible and correspond to the current cost reporting period). [12/31/2004]
1 030	The fiscal year beginning date (record #1, positions 23-29) must be less than or equal to the fiscal year ending date (record #1, positions 30-36). [12/31/2004]

18-526 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 6 - EDITS

R eject Code	Condition
1 035	The vendor code (record #1, positions 38-40) must be a valid code. [12/31/2004]
1 050	The type 1 record #1 must be correct and the first record in the file. [12/31/2004]
1 055	All record identifiers (positions 1-20) must be unique. [12/31/2004]
1 060	Only a Y or N is valid for fields which require a Yes/No response. [12/31/2004]
1 065	Variable column (Worksheet B and Worksheet B-1) must have a corresponding type 2 record (Worksheet A label) with a matching line number. [12/31/2004]
1 070	All line, subline, column, and subcolumn numbers (positions 11-13, 14-15, 16-18, and 19-20, respectively) must be numeric, except for any cost center with accumulated cost as its statistic, which must have its Worksheet B-1 reconciliation column numbered the same as its Worksheet A line number followed by an “A” as part of the line number followed by the subline number. [12/31/2004]
1 075	Cost center integrity must be maintained throughout the cost report. For subscripted lines, the relative position must be consistent throughout the cost report. [12/31/2004]
1 080	For every line used on Worksheets A, B, and C, there must be a corresponding type 2 record. [12/31/2004]
1 090	Fields requiring numeric data (charges, visits, costs, FTEs, etc.) may not contain any alpha character. [12/31/2004]
1 100	In all cases where the file includes both a total and the parts that comprise that total, each total must equal the sum of its parts. [12/31/2004]
1 005S	The cost report ending date must be on or after December 31, 2004. [12/31/2004]
1 010S	The provider number displayed on Worksheet S, Part I, column 1, line 2, must contain six (6) alphanumeric characters. [12/31/2004]
1 015S	The cost report period beginning date (Worksheet S, line 1.03, column 1) must precede the cost report ending date (Worksheet S, line 1.03, column 2). [12/31/2004]
1 020S	The CMHC name, street address, city, state, and zip code (Worksheet S, Part I, column 1, line 1; columns 1 and 2, line 1.01; columns 1 through 3, line 1.02) must be present and valid. [12/31/2004]
1 025S	The CMHC provider number, type of control, type of provider, and certification date (Worksheet S, Part I, columns 1, 2, 4, and 5, line 2) must be present and valid. [12/31/2004]
1 030S	All amounts reported on Worksheet S, Part IV must not be less than zero. [12/31/2004]
1 000A	All amounts reported on Worksheet A, columns 1-3, line 65, must be greater than or equal to zero. [12/31/2004]

Rev. 7 18-527

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 6 - EDITS

R eject Code	Condition
1 020A	For reclassifications reported on Worksheet A-1, the sum of all increases (column 4) must equal the sum of all decreases (column 7). [12/31/2004]
1 025A	For each line on Worksheet A-1, if there is an entry in columns 3, 4, 6, or 7, there must be an entry in column 1. There must be an entry on each line of column 4 for each entry in column 3 (and vice versa), and there must be an entry on each line of column 7 for each entry in column 6 (and vice versa). [12/31/2004]
1 040A	For Worksheet A-3 adjustments on lines 1-12 and 20-21, if either columns 2 or 4 has an entry, then both columns 2 and 4 must have entries, and if any one of columns 0, 1, 2, or 4 for lines 18-19 and subscripts thereof has an entry, then all columns 0, 1, 2, and 4 must have entries. Only valid line numbers may be used in column 4. [12/31/2004]
1 045A	If there are any transactions with related organizations or home offices as defined in CMS Pub. 15-I, chapter 10 (Worksheet A-6, Part A, column 1, line 1 is "Y"), Worksheet A-6, Part B, columns 4 or 5, sum of lines 1-4 must be greater than zero; and Part C, column 1, any one of lines 1-5 must contain any one of alpha characters A through G. Conversely, if Worksheet A-6, Part A, column 1, line 1 is "N", Worksheet A-6, Parts B and C must not be completed. [12/31/2004]
1 050A	Worksheet A-8-2, column 3 must be equal to or greater than the sum of columns 4 and 5 and columns 6 and 7 must each be greater than zero if column 5 is greater than zero. [12/31/2004]
1 000B	On Worksheet B-1, all statistical amounts must be greater than or equal to zero, except for reconciliation columns. [12/31/2004]
1 005B	Worksheet B, column 17, line 64 must be greater than zero. [12/31/2004]
1 010B	For each general service cost center with a net expense for cost allocation greater than zero (Worksheet A, column 7, lines 1-14), the corresponding total cost allocation statistics (Worksheet B-1, column 1, line 1; column 2, line 2; etc.) must also be greater than zero. Exclude from this edit any column that uses accumulated cost as its basis for allocation and any reconciliation column. [12/31/2004]
1 000C	The sum of columns 3 and 4, lines 29 through 39 (and subscripts), must equal column 1 of the corresponding line on Worksheet C. [12/31/2004]
1 000D	If Medicare CMHC visits (Worksheet S, Part IV, column 1, line 27) are greater than zero, then Medicare CMHC costs (Worksheet D, Part I, sum of columns 1 and subscripts, line 12) must be greater than zero. [12/31/2004]

18-528 Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 6 - EDITS

I I. Level II Edits (Potential Rejection Errors)

T hese conditions are usually, but not always, incorrect. These edit errors should be cleared when possible through the cost report. When corrections on the cost report are not feasible, provide additional information in schedules, note form, or any other manner as may be required by your fiscal intermediary (FI). Failure to clear these errors in a timely fashion, as determined by your FI, may be grounds for withholding payments.

Edit	Condition
2 000	All type 3 records with numeric fields and a positive usage must have values equal to or greater than zero (supporting documentation may be required for negative amounts). [12/31/2004]
2 005	Only elements set forth in Table 3, with subscripts as appropriate, are required in the file. [12/31/2004]
2 010	The cost center codes (positions 21-24) (type 2 records) must be a code from Table 5, and each cost center code must be unique. [12/31/2004]
2 015	Standard cost center lines, descriptions, and codes should not be changed. (See Table 5.) This edit applies to the standard line only and not subscripts of that code. [12/31/2004]
2 020	All standard cost center codes must be entered on the designated standard cost center line and subscripts thereof as indicated in Table 5. [12/31/2004]
2 025	Only nonstandard cost center codes within a cost center category may be placed on standard cost center lines of that cost center category. [12/31/2004]
2 030	The standard cost centers listed below must be reported on the lines as indicated and the corresponding cost center codes may only appear on the lines as indicated. No other cost center codes may be placed on these lines or subscripts of these lines, unless indicated herein. [12/31/2004]

C ost Center	Line	Code
C ap Rel Costs-Bldg & Fixt	1	0100-0119
C ap Rel Costs-Mvble Equip	2	0200-0219
E mployee Benefits	3	0300-0319
A dministrative and General	4	0400-0419
M aintenance and Repairs	5	0500-0519
O peration of Plant	6	0600-0619
L aundry and Linen	7	0700-0719
H ousekeeping	8	0800-0819
C afeteria	9	0900-0919
C entral Services and Supply	10	1000-1019
M edical Records and Library	11	1100-1119

Rev. 7 18-529

1895 (Cont.) FORM CMS-2088-92 12-04

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 6 – EDITS

C ost Center		Line		Code
P ro Ed & Training (Apprvd)	12		1200-1219
D rugs and Biologicals	29		2900
O ccupational Therapy	30		3000
P sychiatric / Psychological Services	31		3100
I ndividual Therapy	32		3200
G roup Therapy	33		3300
I ndividualized Activity Therapy	34		3400
F amily Counseling	35		3500
D iagnostic Services	36		2600
P atient Training and Education	37		3700
S heltered Workshops	45		4500
R ecreational Programs	46		4600
R esident Day Camps	47		4700
P re-School Programs	48		4800
D iagnostic Clinics	49		4900
H ome Employment Programs	50		5000
E quipment Loan Service	51		5100
P hysician’s Private Office	52		5200
F und Raising	53		5300
C offee Shop Canteen	54		5400
R esearch	55		5500
I nvestment Property	56		5600
A dvertising	57		5700
F ranchise Fees and Other Assessments	58		5800
P ro Ed & Training (Not Apprvd)	59		5900
M eals & Transportation	61		6100
A ctivity Therapy	62		6200
P sychosocial Programs	63		6300
V ocational Training	64		6400

18-530

Rev. 7

12-04 FORM CMS-2088-92 1895 (Cont.)

ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2088-92

TABLE 6 – EDITS

E dit		Condition
2 035		The administrative and general standard cost center code (0400) may appear only on line 4. [12/31/2004]
2 040		All calendar format dates must be edited for 10 character format, e.g., 01/01/1996 (MM/DD/YYYY). [12/31/2004]
2 045		All dates must be possible, e.g., no "00", no "30", or "31" of February . [12/31/2004]
2 005S		The amount due the provider or program (Worksheet S, Part II, line 6, column 1) should not equal zero. [12/31/2004]
2 020S		The length of the cost reporting period should be greater than 27 days and less than 459 days. [12/31/2004]
2 045S		Worksheet S, Part II, column 2, line 2 (type of control) must have a value of 1 through 12. (See Table 3B.) [12/31/2004]
2 050S		On Worksheet S-2, a response is required for at least one of the questions on lines 3.01or 3.03. [12/31/2004]
2 000A	Worksheet A-1, column 1 (reclassification code) must be alpha characters. [12/31/2004]
2 000B	a. At least one cost center description (lines 1-3), at least one statistical basis label (lines 4-5), and one statistical basis code (line 6) must be present for each general service cost center. This edit applies to all general service cost centers required and/or listed. Exclude any reconciliation columns from this edit. [12/31/2004]
2 005B	b. The column numbering among these worksheets must be consistent. For example, data in capital related costs - buildings and fixtures is identified as coming from column 1 on all applicable worksheets. [12/31/2004]
2 005G	Net income or loss (Worksheet G, column 2, line 32) should not equal zero. [12/31/2004]
2 050G	Total patient revenue (Worksheet F, column 1, line 1) should be equal to or greater than Medicare Part B CMHC charges (Worksheet C, column 1, sum of lines 29.02 through 38.02, respectively. [12/31/2004]
N OTE:	CMS reserves the right to require additional edits to correct deficiencies that become evident after processing the data commences and, as needed, to meet user requirements.

Rev. 7 18-531