REPORT ON THE COST REPORT REVIEW SAN FRANCISCO GENERAL HOSPITAL SAN FRANCISCO, CALIFORNIA part5 pot

... reasonable cost, no further calculation necessary for this schedule. COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES This is trial version www.adultpdf.com STATE OF CALIFORNIA ... 4) COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 5 PROGRAM: NONCONTRACT Provider Name: Fiscal Period Ended...

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... NEW CAP NEW CAP NEW CAP NEW CAP NEW CAP NEW CAP NEW CAP NEW CAP COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS MVBLE EQ BLDG & FIX BLDG 2 BLDG 3 BLDG 5 BLDG 9 BLDG ... CAP OLD CAP OLD CAP OLD CAP OLD CAP OLD CAP TRIAL BALANCE COST ALLOC BLDG & COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS COSTS EXPENSES (From Sch 10) FIXTURES BLDG 2 BLDG 3 BLDG 5 ......

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... TOTAL COMPUTATION OF COST ALLOCATION (W/S B) SCHEDULE 8.2 Fiscal Period Ended: JUNE 30, 2009 NEW CAP NEW CAP NEW CAP NEW CAP NEW CAP NEW CAP ADMINIS- OPERATIONS LAUNDRY & COSTS COSTS COSTS COSTS COSTS COSTS ... version www.adultpdf.com STATE OF CALIFORNIA Provider Name: SAN FRANCISCO GENERAL HOSPITAL GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Cost - Buildings and Fix...

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... Adjusted Report References SAN FRANCISCO GENERAL HOSPITAL Adjustments Explanation of Audit Adjustments JULY 1, 2008 THROUGH JUNE 30, 2009 HSC00228W Cost Report RECLASSIFICATIONS OF REPORTED COSTS 7 ... be reversed on the audit report as they are not applicable to the Medi-Cal Program. CMS Pub. 15-1, Sections 2300, 2302, 2304, and 2306 Page 1 Report References SAN FR...

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... (Decrease) Adjusted Report References SAN FRANCISCO GENERAL HOSPITAL Adjustments Explanation of Audit Adjustments JULY 1, 2008 THROUGH JUNE 30, 2009 HSC00228W Cost Report ADJUSTMENTS TO REPORTED MEDI-CAL ... Line Col. Reported (Decrease) Adjusted Report References SAN FRANCISCO GENERAL HOSPITAL Adjustments Explanation of Audit Adjustments JULY 1, 2008 THROUGH JUNE 30,...

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... COST This is trial version www.adultpdf.com REPORT ON THE COST REPORT REVIEW CENTINELA HOSPITAL MEDICAL CENTER INGLEWOOD, CALIFORNIA PROVIDER NUMBER: HSC30240H NATIONAL PROVIDER IDENTIFIERS: ... examined the provider's Medi-Cal Cost Report for the above-referenced fiscal period. Our examination was made under the authority of Section 14170 of the We...

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... reasonable cost, no further calculation necessary for this schedule. COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES This is trial version www.adultpdf.com STATE OF CALIFORNIA ... MEDI-CAL ANCILLARY COSTS TOTAL COST * CHARGES MEDI-CAL (Adj 3) COSTCHARGES (From Schedule 6) ANCILLARY This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 4B PROGRAM:...

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... ACCUMULATE TRATIVE & COST BENEFITS COST COST COST COST COST COST COST COST COST GENERAL 4.08 5.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.00 COMPUTATION OF COST ALLOCATION (W/S B) 0 48,943 0 0 0 0 0 0 0 0 13,482,643 2,319,651 0 0 0 0 0 0 0 0 0 0 0 0 0 25,346 0 0 0 0 0 0 0 0 3,536,622 608,466 0 594 0 0 0 0 0 0 0 0 234,930 40,419 029,265000000004,737,187815,020 08,27500000...

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... ) STATISTICS FOR COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: CENTINELA HOSPITAL MEDICAL CENTER GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg ... trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: CENTINELA HOSPITAL MEDICAL CENTER GENERAL SERVICE COST CENTERS 1.00 Old Cap Rel Costs-Bldg &...

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... Sections 2304, 2404, and 2408 CCR, Title 22, Section 51541 Page 6 This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: CENTINELA HOSPITAL MEDICAL CENTER GENERAL SERVICE COST ... HSC30240H Cost Report ADJUSTMENTS TO REPORTED MEDI-CAL SETTLEMENT DATA - CONTRACT 8 Contract 4 D-1 I XIX 9.00 1 Medi-Cal Inpatient Days - Adults and Pediatrics 13,474 (7,808) 5,666 Co...

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