STATE OF CALIFORNIA COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST part2 docx
STATE OF CALIFORNIA COMPUTATION OF MEDICAL INPATIENT ROUTINE SERVICE COST_PART2 docx
... ALLOC 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
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
48,012
0
0
0
0
0
0
0
0
23,491,233
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0
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0
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324
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0
2,721,654
731...
STATE OF CALIFORNIA COMPUTATION OF MEDICAL INPATIENT ROUTINE SERVICE COST_PART3 potx
... version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPITAL
GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs-Bldg & Fixtures
2.00 Old Cap Rel Costs-Movable ... version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPIT
TRIAL BALANCE
EXPENSES
GENERAL SERVICE COST CENTER
1.00
Old Cap Rel Cos...
STATE OF CALIFORNIA COMPUTATION OF MEDICAL INPATIENT ROUTINE SERVICE COST_PART4 docx
... TO REPORTED COSTS
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
USC KENNETH NORRIS JR. CANCER HOSPITAL
GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Costs-Bldg & ... 1
GENERAL SERVICE COST CENTERS
1.00
Old Cap Rel Costs-Bldg & Fixtures
$0
2.00
Old Cap Rel Costs-Movable Equipment
0
3.00
New Cap Rel Costs-Bldg & Fixtures
491,203
491,203
4.0...
STATE OF CALIFORNIA SCHEDULE 4B PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST _part1 pot
...
REASONABLE COST OF MEDI-CAL INPATIENT SERVICES
1. Cost of Covered Services (Desig Pub Hosp Sch 3) $ 100,559,823 $ 106,613,078
CHARGES FOR MEDI-CAL INPATIENT SERVICES
2. Inpatient Routine Service ... (430,158)
11. Net Cost of Covered Services Rendered to Medi-Cal
Inpatients $ 100,059,542 $ 105,991,878
(To Desig Pub Hosp Sch 1)
COMPUTATION OF
MEDI-CAL NET CO...
STATE OF CALIFORNIA SCHEDULE 4B PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST _part2 pptx
... 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 ... 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 ....
STATE OF CALIFORNIA SCHEDULE 4B PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST _part3 pptx
... STATE OF CALIFORNIA
Provider Name:
SAN FRANCISCO GENERAL HOSPITAL
GENERAL SERVICE COST CENTERS
1.00 Old Cap Rel Cost - Buildings and Fixtures
1.01 Old Cap Rel Cost - Building ... SERVICE COST CENTERS
1.00 Old Cap Rel Cost - Buildings and Fixtures
1.01 Old Cap Rel Cost - Building 2
1.02 Old Cap Rel Cost - Building 3
1.03 Old Cap Rel Cost - Building 5
1.05 Old Cap Rel...
STATE OF CALIFORNIA SCHEDULE 4B PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST _part4 doc
... BALANCE OF EXPENSES
ADJUSTMENTS
This is trial version
www.adultpdf.com
STATE OF CALIFORNIA
Provider Name:
SAN FRANCISCO GENERAL HOSPITAL
GENERAL SERVICE COST CENTER
1.00 Old Cap Rel Cost - Buildings ... version
www.adultpdf.com
STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
SAN FRANCISCO GENERAL HOSPITAL JUNE 30, 2009
GENERAL SERVICE COST CENTE...
STATE OF CALIFORNIA SCHEDULE 4B PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST _part5 pot
... State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
31
Adj. Audit Work As ... Sections 2300, 2304, and 2306
Page 7
This is trial version
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State of California Department of Health Care Services
Provider Name Fiscal Period Provider Number
31
Adj. Audit Work As ... 15-1, Sections 2300 and 2409
Page 12
This is trial ve...
STATE OF CALIFORNIA SCHEDULE 4A PROGRAM: NONCONTRACT COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST pot
... Inpatient Days (Adj 29) 0 158
31. Cost Applicable to Medi-Cal $ 0 $ 50,236
32. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,28,31) $ 0 $ 110,197
(To Schedule 4)
COMPUTATION OF
MEDI-CAL INPATIENT ... (27,072) $ (30,907)
11. Net Cost of Covered Services Rendered to Medi-Cal
Inpatients $ 67,438,981 $ 71,523,814
(To Contract Sch 1)
COMPUTATION OF
MEDI-CAL N...
STATE OF CALIFORNIA COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST_part1 pot
... Diem Cost $ 0.00 $ 0.00
29. Medi-Cal Inpatient Days (Adj ) 0 0
30. Cost Applicable to Medi-Cal $ 0 $ 0
31. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,30) $ 0 $ 0
(To Contract Sch 4)
COMPUTATION ... Per Diem Cost $ 0.00 $ 0.00
24. Medi-Cal Inpatient Days (Adj ) 0 0
25. Cost Applicable to Medi-Cal $ 0 $ 0
26. Total Inpatient Routine Cost (Sch 8, Lin...
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