REPORT ON THE COST REPORT REVIEW MARIAN MEDICAL CENTER SANTA MARIA part5 doc

... 2 PROGRAM: NONCONTRACT Provider Name: Fiscal Period Ended: MARIAN MEDICAL CENTER JUNE 30, 2009 Provider No. ZZT30107G REPORTED AUDITED REASONABLE COST OF MEDI-CAL INPATIENT SERVICES 1. Cost of Covered ... version www.adultpdf.com STATE OF CALIFORNI A SCHEDULE A-4 PROGRAM: NONCONTRACT Provider Name: Fiscal Period Ended: MARIAN MEDICAL CENTER JUNE 30,2009 Provider No.: ZZT30107...

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... EQUIP COST COST COST COST COST COST COST 0.00 1.00 2.00 3.00 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 COMPUTATION OF COST ALLOCATION (W/S B) GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg ... 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...

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... COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: MARIAN MEDICAL CENTER TRIAL BALANCE EXPENSES GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg ... COST ALLOCATION (W/S B-1) This is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: MARIAN MEDICAL CENTER TRIAL BALANCE EXPENSES GENERAL SERVICE COST C...

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... inpatients in Noncontract acute hospitals are subject to various reimbursement limitations identified in AB 5. W&I Code, Section 14105.245 Page 1 Report References MARIAN MEDICAL CENTER Adjustments Explanation ... is trial version www.adultpdf.com STATE OF CALIFORNIA Provider Name: MARIAN MEDICAL CENTER GENERAL SERVICE COST CENTER 1.00 Old Cap Rel Costs-Bldg &...

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... Col. Reported (Decrease) Adjusted Report References MARIAN MEDICAL CENTER Adjustments Explanation of Audit Adjustments JULY 1, 2008 THROUGH JUNE 30, 2009 ZZT30107H Cost Report ADJUSTMENTS TO REPORTED ... Number 29 Adj. Audit Work As Increase As No. Report Sheet Part Title Line Col. Reported (Decrease) Adjusted Report References MARIAN MEDICAL CENTER Adjustments Explanati...

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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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... charges exceed 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 ... Findings) COMPUTATION OF MEDI-CAL CONTRACT COST This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 4A Provider Name: Fiscal Period Ended: CENTINELA HOSPITAL MEDICAL...

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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 08,2750000000...

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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 & Fixt...

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... HSC30240H Cost Report ADJUSTMENTS TO REPORTED MEDI-CAL SETTLEMENT DATA - NONCONTRACT 4 4A Not Reported Medi-Cal Administrative Days (Feb 1, 2008 through Jul 31, 2008) 0 171 171 4A Not Reported ... Col. Reported (Decrease) Adjusted Report References CENTINELA HOSPITAL MEDICAL CENTER Adjustments Explanation of Audit Adjustments FEBRUARY 1, 2008 THROUGH DECEMBER 31, 2008 HSC30240H Cos...

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