Electronic Cost Report Exhibit Templates with Instructions

CMS Templates

CMS has published several new templates that will be required as part of the cost report submission process. We have reviewed these templates and added an additional tab with instructions to make this as straightforward as possible.

 

Template
PPS Hospitals
CAH Hospitals
Freestanding Facilities (HHA, FQHC, RHC, ESRD)
MedicareBD 2552-10 (Hospital) Exhibit 2A Template with Instructions (XLSX)
Applies
Applies
Not Applicable
MedicaidEligDays 2552-10 (Hospital) Exhibit 3A Template with Instructions (XLSX)
Applies
Not Applicable
Not Applicable
Charity 2552-10 (Hospital) Exhibit 3B Template with Instructions (XLSX)
Applies
Note: If hospital is a DHCG presumptive charity client, DHCG will be able to provide this data in the proper format.
Applies
Note: If hospital is a DHCG presumptive charity client, DHCG will be able to provide this data in the proper format.
Not Applicable
TotalBD 2552-10 (Hospital) Exhibit 3C Template with Instructions (XLSX)
Applies
Not Applicable
Not Applicable
S-10 Template Instructions (XLSX)
Applies
Note: If hospital is a DHCG presumptive charity client, DHCG will be able to provide Ln 20–23.
Applies
Note: If hospital is a DHCG presumptive charity client, DHCG will be able to provide Ln 20–23.
Not Applicable
MedicareBD 1728-20 (HHA) Exhibit 1 Template with Instructions (XLSX)
Not Applicable
Not Applicable
Applies
MedicareBD RHC, CMHC, FQHC, ESRD, SNF Exhibit 1 Template with Instructions (XLSX)
Not Applicable
Not Applicable
Applies

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