REPORT ON THE COST REPORT REVIEW CENTINELA HOSPITAL MEDICAL CENTER INGLEWOOD, CALIFORNIA PROVIDER NUMBER: HSC30240H NATIONAL PROVIDER IDENTIFIERS: 1336328244 AND 1619936440 FISCAL PERIOD FEBRUARY 1, 2008 TO DECEMBER 31, 2008 part3 docx

... Fullerton, CA 92835 PROVIDER: CENTINELA HOSPITAL MEDICAL CENTER PROVIDER NO.: HSC30240H NATIONAL PROVIDER INDENTIFIERS: 1336328244 AND 1619936440 FISCAL PERIOD: FEBRUARY 1, 2008 TO DECEMBER 31, ... SERVICE COST This is trial version www.adultpdf.com REPORT ON THE COST REPORT REVIEW CENTINELA HOSPITAL MEDICAL CENTER INGLEWOOD...

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... OF CALIFORNIA CONTRACT SCH 5 Provider Name: Fiscal Period Ended: CENTINELA HOSPITAL MEDICAL CENTER DECEMBER 31, 2008 Provider No: HSC30240H RATIO COST TO CHARGES ANCILLARY COST CENTERS 37.00 Operating ... SERVICES COMPUTATION OF This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 4B Provider Name: Fiscal Period Ended: CENTINELA HO...

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... Transitional Care Unit 000000000000 This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH 7 Provider Name: Fiscal Period Ended: CENTINELA HOSPITAL MEDICAL CENTER DECEMBER 31, 2008 Provider ... II 36.02 Transitional Care Unit This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 8 Provider Name: Fiscal Period Ended: CENTINELA H...

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... STATE OF CALIFORNIA SCHEDULE 10 Provider Name: Fiscal Period Ended: CENTINELA HOSPITAL MEDICAL CENTER DECEMBER 31, 2008 GENERAL SERVICE COST CENTERS (From Sch 10A) AUDITEDREPORTED ADJUSTMENTS TRIAL ... 4,391 This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 10A Page 1 Provider Name: Fiscal Period Ended: CENTINELA HOSPITAL MEDICAL CENTE...

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... Adjusted Report References CENTINELA HOSPITAL MEDICAL CENTER Adjustments Explanation of Audit Adjustments FEBRUARY 1, 2008 THROUGH DECEMBER 31, 2008 HSC30240H Cost Report ADJUSTMENTS TO REPORTED ... Paid Claims Summary: Report Date: February 18, 2010 Payment Period: February 1, 2008 through December 31, 2009 Service Period : Feberuary 1, 20...

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... version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 5 PROGRAM: NONCONTRACT Provider Name: Fiscal Period Ended: SAN FRANCISCO GENERAL HOSPITAL JUNE 30, 2009 Provider No: ZZR00228W RATIO COST TO CHARGES ANCILLARY ... reasonable cost, no further calculation necessary for this schedule. COMPUTATION OF LESSER OF MEDI-CAL REASONABLE COST OR CUSTOMARY CHARGES This is trial versi...

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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 ... 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 BLDG 10 BLDG 20 BLDG 30 BLDG MRI BLDG 80 BLDG 90 LAND...

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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 ... 23,401 510,192 11,0 68,178 27,603,446 23,401 23,401 628,038 23,401 5,430 12,777 3,512,462 5,027,221 5,430 5,430 39,039 5,430 5,632 106,372 2,593,514 5,292,035 5,632 5,632...

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... 15,900,440 * To adjust the provider& apos;s reclassification of medical supplies charged to patients to agree with the supporting documentations. CMS Pub. 15 -1, Sections 2300, 2304, and 2306 4 ... Adjustments JULY 1, 2008 THROUGH JUNE 30, 2009 HSC00228W Cost Report This is trial version www.adultpdf.com STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS SCHEDULE 10...

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... HOSPITAL Adjustments Explanation of Audit Adjustments JULY 1, 2008 THROUGH JUNE 30, 2009 HSC00228W Cost Report ADJUSTMENTS TO REPORTED COSTS 9 10A A 6.00 7 Administrative and General * $85,292,593 ($2 01,2 32) $85,0 91,3 61 To ... Requisitions 25,359,374 (4,405,182) 20,954,192 To adjust costed requisitions statistics to agree with the provider& apos;s records and for...

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