STATE OF CALIFORNIA COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST part4 doc
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
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STATE OF CALIFORNIA
Provider Name:
SAN FRANCISCO GENERAL HOSPITAL
GENERAL SERVICE COST CENTER
1.00 Old Cap Rel Cost - Buildings ... version
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STATE OF CALIFORNIA SCHEDULE 10
Provider Name: Fiscal Period Ended:
SAN FRANCISCO GENERAL HOSPITAL JUNE 30, 2009
GENERAL SERVICE COST CENTE...
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
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0
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48,012
0
0
0
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23,491,233
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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
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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
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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
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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 _part5 pot
... provider's
supporting documents.
CMS Pub. 15-1, Sections 2300, 2304, and 2306
Page 7
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State of California Department of Health Care Services
Provider Name ... 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 v...
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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