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Medicare Cost Report Instructions for CMS Form 2552-10, Worksheet D-1 and Medicare Cost Report Software

What is worksheet D-1 and how can Medicare Cost Report software help?

D-1 is an important worksheet because it summarizes the routine per diem cost for the Medicare and Medicaid programs. It is probably one of the most important cost report worksheets, and of course, is used for computation of the operating ratio of cost-to-charges.

I’d like to give a brief example of how the worksheet pulls together key pieces of information.

Let’s start with a clean copy of S-3, Part 1:

1. In column 6, line 1, enter 100 as the number of routine adult and pediatric beds. If we were to omit all other payors, we could say that the provider serviced only 100 Title XVIII patients.

2. Next, we should move to C, Part 1 and take note of the final general inpatient cost for Adults & Pediatrics (line 30). In this example I will use $85,928 as the final cost. Generally, your medicare cost report software (or medicaid cost report software) will pull the data for you onto D-1. (Of note, the final cost amount was picked arbitrarily.)

3. Next, find D-1. Line 1 will contains the Adults + Pediatrics days, inclusive of swing-bed and private, but exclusive of nursery days. Nursery days are reported separately for Medicaid and Title V.

4. The real line we need is line 2, which exclude all those pesky swing-bed and nursery days, but include private days. Our total: 100 days.

5. We jump down to line 37. It asks for our cost, which is still $85,928 (remember, we didn’t perform any swing-bed or private room differential adjustment).

6. We divide line 37 ($85,928) by line 2 (100) to achieve an inpatient per diem on the Medicare cost report of $859.28.

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