PROGRAM: PSYCHIATRIC COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN''''S REMUNERATION _part3 pdf

STATE OF CALIFORNIA SCHEDULE 7-1 PROGRAM: PSYCHIATRIC Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSM 30625F PROFESSIONAL SERVICE COST CENTERS 40.00 Anesthesiology $ 0 $ 0 0.000000 $ $ 0 41.00 Radiology - Diagnostic 0 0 0.000000 0 43.00 Radioisotope 0 0 0.000000 0 44.00 Laboratory 0 0 0.000000 0 53.00 Electrocardiology 0 0 0.000000 0 54.00 Electroencephalography 0 0 0.000000 0 61.00 Emergency 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 TOTAL $ 0 $ 0 $ 0 $ 0 (To Schedule 3-1) COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN'S REMUNERATION (Adj ) TOTAL CHARGES TO ALL PATIENTS (Adj ) HBP REMUNERATION TO CHARGES MEDI-CAL CHARGES MEDI-CAL COSTREMUNERATION RATIO OF (Adj ) This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 1-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F REPORTED AUDITED 1. Net Cost of Covered Services Rendered to Medi-Cal Patients (Schedule 3-2) $ 292,277 $ 0 2. Excess Reasonable Cost Over Charges (Schedule 2-2) $ 0 $ 0 3. Medi-Cal Inpatient Hospital Based Physician Services $ 0 $ 0 4. $ 0 $ 0 5. TOTAL COST - Reimbursable to Provider (Lines 1 through 4) $ 292,277 $ 0 6. Interim Payments (Adj 22) $ (292,277) $ 0 7. Balance Due Provider (State) $ 0 $ 0 8. Duplicate Payments (Adj ) $ 0 $ 0 9. $ 0 $ 0 10. $0 $0 11. TOTAL MEDI-CAL SETTLEMENT Due Provider (State) $ 0 $ 0 (To Summary of Findings) COMPUTATION OF MEDI-CAL REIMBURSEMENT SETTLEMENT This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 2-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F REPORTED AUDITED REASONABLE COST OF MEDI-CAL INPATIENT SERVICES 1. Cost of Covered Services (Schedule 3-2) $ 292,277 $ 0 CHARGES FOR MEDI-CAL INPATIENT SERVICES 2. Inpatient Routine Service Charges (Adj 21) $ 419,330 $ 0 3. Inpatient Ancillary Service Charges (Adj 21) $ 549,829 $ 0 4. Total Charges - Medi-Cal Inpatient Services $ 969,159 $ 0 5. Excess of Customary Charges Over Reasonable Cost (Line 4 minus Line 1) * $ 676,882 $ 0 6. Excess of Reasonable Cost Over Customary Charges (Line 1 minus Line 4) $ 0 $ 0 (To Schedule 1-2) * If 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 OF CALIFORNIA SCHEDULE 3-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F REPORTED AUDITED 1. Medi-Cal Inpatient Ancillary Services (Schedule 5-2) $ 107,260 $ 0 2. Medi-Cal Inpatient Routine Services (Schedule 4-2) $ 185,017 $ 0 3. Medi-Cal Inpatient Hospital Based Physician for Intern and Resident Services (Sch ) $ 0 $ 0 4. $ 0 $ 0 5. $ 0 $ 0 6. SUBTOTAL (Sum of Lines 1 through 5) $ 292,277 $ 0 7. Medi-Cal Inpatient Hospital Based Physician for Acute Care Services (Schedule 7-2) $ 0 $ 0 8. SUBTOTAL $ 292,277 $ 0 (To Schedule 2-2) 9. Coinsurance (Adj ) $ 0 $ 0 10. Patient and Third Party Liability (Adj ) $ 0 $ 0 11. Net Cost of Covered Services Rendered to Medi-Cal Inpatients $ 292,277 $ 0 (To Schedule 1-2) COMPUTATION OF MEDI-CAL NET COSTS OF COVERED SERVICES This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 4-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F GENERAL SERVICE UNIT NET OF SWING-BED COSTS REPORTED AUDITED INPATIENT DAYS 1. Total Inpatient Days (include private & swing-bed) (Adj 7) 8,598 0 2. Inpatient Days (include private, exclude swing-bed) 8,598 0 3. Private Room Days (exclude swing-bed private room) (Adj ) 0 0 4. Semi-Private Room Days (exclude swing-bed) (Adj 7) 8,598 0 5. Medicare NF Swing-Bed Days through Dec 31 (Adj ) 0 0 6. Medicare NF Swing-Bed Days after Dec 31 (Adj ) 0 0 7. Medi-Cal NF Swing-Bed Days through July 31 (Adj ) 0 0 8. Medi-Cal NF Swing-Bed Days after July 31 (Adj ) 0 0 9. Medi-Cal Days (excluding swing-bed) (Adj 19) 146 0 SWING-BED ADJUSTMENT 17. Medicare NF Swing-Bed Rates through Dec 31 (Adj ) $ 0.00 $ 0.00 18. Medicare NF Swing-Bed Rates after Dec 31(Adj ) $ 0.00 $ 0.00 19. Medi-Cal NF Swing-Bed Rates through July 31(Adj ) $ 0.00 $ 0.00 20. Medi-Cal NF Swing-Bed Rates after July 31(Adj ) $ 0.00 $ 0.00 21. Total Routine Serv Cost (Sch 8, Part I, Line 31, Col 27) $ 10,895,759 $ 0 22. Medicare NF Swing-Bed Cost through Dec 31 (L 5 x L 17) $ 0 $ 0 23. Medicare NF Swing-Bed Cost after Dec 31 (L 6 x L 18) $ 0 $ 0 24. Medi-Cal NF Swing-Bed Cost through July 31 (L 7 x L 19) $ 0 $ 0 25. Medi-Cal NF Swing-Bed Cost after July 31 (L 8 x L 20) $ 0 $ 0 26. Total Swing-Bed Cost (Sum of Lines 22 to 25) $ 0 $ 0 27. Inpatient Routine Cost Net of Swing-Bed (L 21 minus L 26) $ 10,895,759 $ 0 PRIVATE ROOM DIFFERENTIAL ADJUSTMENT 28. Gen Inpatient Routine Serv Charges (excl swing-bed charges)(Adj 9) $ 24,816,770 $ 0 29. Private Room Charges (excluding swing-bed charges)(Adj ) $ 0 $ 0 30. Semi-Private Room Charges (excluding swing-bed charges)(Adj 9) $ 24,816,770 $ 0 31. Gen Inpatient Routine Service Cost/Charge Ratio (L 27 / L 28) $ 0.439048 $ 0.000000 32. Average Private Room Per Diem Charge (L 29 / L 3) $ 0.00 $ 0.00 33. Average Semi-Private Room Per Diem Charge (L 30 / L 4) $ 2,886.34 $ 0.00 34. Avg Per Diem Prvt Room Charge Differential (L 32 minus L 33) $ 0.00 $ 0.00 35. Average Per Diem Private Room Cost Differential (L 31 x L 34) $ 0.00 $ 0.00 36. Private Room Cost Differential Adjustment (L 35 x L 3) $ 0 $ 0 37. Inpatient Rout Cost Net of Swing-Bed & Prvt Rm (L 27 minus L 36) $ 10,895,759 $ 0 PROGRAM INPATIENT OPERATING COST 38. Adjusted General Inpatient Routine Cost Per Diem (L 37 / L 2) $ 1,267.24 $ 0.00 39. Program General Inpatient Routine Service Cost (L 9 x L 38) $ 185,017 $ 0 40. Cost Applicable to Medi-Cal (Schedule 4A-2) $ 0 $ 0 41. Cost Applicable to Medi-Cal (Schedule 4B-2) $ 0 $ 0 42. TOTAL MEDI-CAL ROUTINE COST (Sum of Lines 39, 40 & 41) $ 185,017 $ 0 (To Schedule 3-2) COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 4A-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F SPECIAL CARE AND/OR NURSERY UNITS REPORTED AUDITED NURSERY 1. Total Inpatient Routine Cost (Sch 8, Line 33, Col 27) $ 7,910,324 $ 7,910,329 2. Total Inpatient Days (Adj ) 16,584 16,584 3. Average Per Diem Cost $ 476.99 $ 476.99 4. Medi-Cal Inpatient Days (Adj ) 0 0 5. Cost Applicable to Medi-Cal $ 0 $ 0 INTENSIVE CARE UNIT 6. Total Inpatient Routine Cost (Sch 8, Line 26, Col 27) $ 34,664,749 $ 34,664,771 7. Total Inpatient Days (Adj ) 10,680 10,680 8. Average Per Diem Cost $ 3,245.76 $ 3,245.77 9. Medi-Cal Inpatient Days (Adj ) 0 0 10. Cost Applicable to Medi-Cal $ 0 $ 0 CORONARY CARE UNIT 11. Total Inpatient Routine Cost (Sch 8, Line 27, Col 27) $ 2,780,566 $ 2,780,568 12. Total Inpatient Days (Adj ) 890 890 13. Average Per Diem Cost $ 3,124.23 $ 3,124.23 14. Medi-Cal Inpatient Days (Adj ) 0 0 15. Cost Applicable to Medi-Cal $ 0 $ 0 SURGICAL INTENSIVE CARE UNIT 16. Total Inpatient Routine Cost (Sch 8, Line 29, Col 27) $ 23,895,533 $ 23,895,548 17. Total Inpatient Days (Adj ) 7,325 7,325 18. Average Per Diem Cost $ 3,262.19 $ 3,262.19 19. Medi-Cal Inpatient Days (Adj ) 0 0 20. Cost Applicable to Medi-Cal $ 0 $ 0 SURGICAL ICU-8 21. Total Inpatient Routine Cost (Sch 8, Line 29.01, Col 27) $ 22,082,665 $ 22,082,681 22. Total Inpatient Days (Adj ) 7,306 7,306 23. Average Per Diem Cost $ 3,022.54 $ 3,022.54 24. Medi-Cal Inpatient Days (Adj 20) 0 0 25. Cost Applicable to Medi-Cal $ 0 $ 0 ADMINISTRATIVE DAYS 26. Per Diem Rate (Adj ) $ 0.00 $ 0.00 27. Medi-Cal Inpatient Days (Adj ) 0 0 28. Cost Applicable to Medi-Cal $ 0 $ 0 ADMINISTRATIVE DAYS 29. Per Diem Rate (Adj ) $ 0.00 $ 0.00 30. Medi-Cal Inpatient Days (Adj ) 0 0 31. Cost Applicable to Medi-Cal $ 0 $ 0 32. Medi-Cal Routine Cost (Sum of Lines 5,10,15,20,25,28,31) $ 0 $ 0 (To Schedule 4-2) COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 4B-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F SPECIAL CARE UNITS REPORTED AUDITED PEDIATRIC INTENSIVE CARE UNIT 1. Total Inpatient Routine Cost (Sch 8, Line 29.03, Col 27) $ 7,410,985 $ 7,410,989 2. Total Inpatient Days (Adj ) 1,912 1,912 3. Average Per Diem Cost $ 3,876.04 $ 3,876.04 4. Medi-Cal Inpatient Days (Adj ) 0 0 5. Cost Applicable to Medi-Cal $ 0 $ 0 NEONATAL INTENSIVE CARE UNIT 6. Total Inpatient Routine Cost (Sch 8, Line 30, Col 27) $ 32,319,451 $ 32,319,475 7. Total Inpatient Days (Adj ) 14,302 14,302 8. Average Per Diem Cost $ 2,259.79 $ 2,259.79 9. Medi-Cal Inpatient Days (Adj ) 0 0 10. Cost Applicable to Medi-Cal $ 0 $ 0 N/A 11. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 12. Total Inpatient Days (Adj ) 0 0 13. Average Per Diem Cost $ 0.00 $ 0.00 14. Medi-Cal Inpatient Days (Adj ) 0 0 15. Cost Applicable to Medi-Cal $ 0 $ 0 N/A 16. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 17. Total Inpatient Days (Adj ) 0 0 18. Average Per Diem Cost $ 0.00 $ 0.00 19. Medi-Cal Inpatient Days (Adj ) 0 0 20. Cost Applicable to Medi-Cal $ 0 $ 0 N/A 21. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 22. Total Inpatient Days (Adj ) 0 0 23. Average Per Diem Cost $ 0.00 $ 0.00 24. Medi-Cal Inpatient Days (Adj ) 0 0 25. Cost Applicable to Medi-Cal $ 0 $ 0 N/A 26. Total Inpatient Routine Cost (Sch 8, Line ___, Col 27) $ 0 $ 0 27. Total Inpatient Days (Adj ) 0 0 28. Average Per 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 Schedule 4-2) COMPUTATION OF MEDI-CAL INPATIENT ROUTINE SERVICE COST This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 5-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F RATIO COST TO CHARGES ANCILLARY COST CENTERS 37.00 Operating Room $ 95,710,199 $ 585,456,449 0.163480 $ 0 $ 0 39.00 Delivery Room and Labor Room 29,518,483 75,488,257 0.391034 0 0 40.00 Anesthesiology 55,602,856 446,285,096 0.124590 0 0 41.00 Radiology-Diagnostic 49,746,582 193,969,630 0.256466 0 0 43.01 Ultrasound 4,215,379 29,801,839 0.141447 0 0 43.02 CAT Scan 12,997,062 201,731,626 0.064427 0 0 44.00 Laboratory 81,858,827 694,170,211 0.117923 0 0 44.01 Laboratory-Pathological 25,512,941 62,236,846 0.409933 0 0 44.02 HLA Lab 4,969,551 11,666,069 0.425983 0 0 47.00 Blood Storing, Processing & Trans 25,970,759 39,817,972 0.652237 0 0 49.00 Respiratory Therapy 29,840,758 292,629,267 0.101975 0 0 50.00 Physical Therapy 11,777,981 41,779,821 0.281906 0 0 51.00 Occupational Therapy 4,439,833 22,511,543 0.197225 0 0 52.00 Speech Pathology 1,689,666 8,339,831 0.202602 0 0 53.00 Electrocardiology 13,588,420 98,869,613 0.137438 0 0 54.00 Electroencephalography 4,408,169 21,049,131 0.209423 0 0 54.01 Electromyography 166,799 1,342,237 0.124269 0 0 55.00 Medical Supplies Charged to Patients 125,543,810 522,478,410 0.240285 0 0 56.00 Drugs Charged to Patients 93,304,736 462,202,429 0.201870 0 0 57.00 Renal Dialysis 8,102,366 31,845,109 0.254430 0 0 59.00 Gastro Intestinal Services 17,677,073 51,780,517 0.341385 0 0 59.01 Eye Laboratory 116,474 643,684 0.180950 0 0 59.02 Cardiac Catheterization Laboratory 10,383,847 81,800,167 0.126942 0 0 59.03 Vascular Laboratory 4,491,186 49,819,261 0.090150 0 0 59.04 Psychiatric/Psychological Services 948,688 4,444,067 0.213473 0 0 59.05 Nuclear Medicine - Therapeutic 14,418,226 116,313,021 0.123961 0 0 59.06 Magnetic Resonance Imaging 15,976,382 140,454,524 0.113748 0 0 59.07 Pulmonary Function Testing 1,901,599 3,728,114 0.510070 0 0 59.08 Recreational Therapy 139,834 833,837 0.167700 0 0 60.00 Clinic 5,867,508 3,544,413 1.655425 0 0 60.01 Psychiatric Clinic 4,048,115 6,939,317 0.583359 0 0 60.02 Medical Oncology 101,988,606 315,812,474 0.322940 0 0 60.03 Psych - Partial Hospitalization 894,863 2,902,036 0.308357 0 0 60.04 Clinic 2 - Gen Risk Center 406,378 124,968 3.251855 0 0 60.05 Clinic 3 - Neuro Surgical Institute 5,137,193 1,367,847 3.755678 0 0 60.06 Clinic 4 - Prostate Cancer Program 463,111 194,947 2.375574 0 0 60.07 Clinic 5 -Endocrinology Center 1,082,093 973,406 1.111657 0 0 60.08 Clinic 6 - Spine Injury Institute 4,253,159 2,992,983 1.421044 0 0 60.09 Clinic 7 - Pediatric Center 2,929,172 1,490,379 1.965387 0 0 61.00 Emergency 38,372,548 260,197,483 0.147475 0 0 TOTAL $ 910,461,233 $ 4,890,028,831 $ 0 $ 0 (To Schedule 3-2) * From Schedule 8, Column 27 (Schedule 6-2) MEDI-CAL COST * TOTAL ANCILLARY CHARGES (Adj ) COST SCHEDULE OF MEDI-CAL ANCILLARY COSTS TOTAL ANCILLARY MEDI-CAL CHARGES This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 6-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F ANCILLARY CHARGES 37.00 Operating Room $ 10,034 $ (10,034) $ 0 39.00 Delivery Room and Labor Room 0 0 40.00 Anesthesiology 0 0 41.00 Radiology-Diagnostic 4,998 (4,998) 0 43.01 Ultrasound 0 0 43.02 CAT Scan 11,602 (11,602) 0 44.00 Laboratory 113,574 (113,574) 0 44.01 Laboratory-Pathological 0 0 44.02 HLA Lab 0 0 47.00 Blood Storing, Processing & Trans 1,573 (1,573) 0 49.00 Respiratory Therapy 17,756 (17,756) 0 50.00 Physical Therapy 95,372 (95,372) 0 51.00 Occupational Therapy 104,181 (104,181) 0 52.00 Speech Pathology 30,309 (30,309) 0 53.00 Electrocardiology 1,820 (1,820) 0 54.00 Electroencephalography 0 0 54.01 Electromyography 0 0 55.00 Medical Supplies Charged to Patients 20,031 (20,031) 0 56.00 Drugs Charged to Patients 56,206 (56,206) 0 57.00 Renal Dialysis 0 0 59.00 Gastro Intestinal Services 0 0 59.01 Eye Laboratory 0 0 59.02 Cardiac Catheterization Laboratory 0 0 59.03 Vascular Laboratory 12,999 (12,999) 0 59.04 Psychiatric/Psychological Services 0 0 59.05 Nuclear Medicine - Therapeutic 4,677 (4,677) 0 59.06 Magnetic Resonance Imaging 19,959 (19,959) 0 59.07 Pulmonary Function Testing 0 0 59.08 Recreational Therapy 7,035 (7,035) 0 60.00 Clinic 0 0 0 60.01 Psychiatric Clinic 0 0 0 60.02 Medical Oncology 37,703 (37,703) 0 60.03 Psych - Partial Hospitalization 0 0 0 60.04 Clinic 2 - Gen Risk Center 0 0 0 60.05 Clinic 3 - Neuro Surgical Institute 0 0 0 60.06 Clinic 4 - Prostate Cancer Program 0 0 0 60.07 Clinic 5 -Endocrinology Center 0 0 0 60.08 Clinic 6 - Spine Injury Institute 0 0 0 60.09 Clinic 7 - Pediatric Center 0 0 0 61.00 Emergency 0 0 0 TOTAL MEDI-CAL ANCILLARY CHARGES $ 549,829 $ (549,829) $ 0 (To Schedule 5-2) ADJUSTMENTS TO MEDI-CAL CHARGES REPORTED ADJUSTMENTS AUDITED (Adj 20) This is trial version www.adultpdf.com STATE OF CALIFORNIA SCHEDULE 7-2 PROGRAM: REHABILITATION Provider Name: Fiscal Period Ended: CEDARS-SINAI MEDICAL CENTER JUNE 30, 2008 Provider No: HSC 30625F HBP TOTAL CHARGES RATIO OF MEDI-CAL MEDI-CAL PROFESSIONAL SERVICE REMUNERATION TO ALL PATIENTS CHARGES COST COST CENTERS TO CHARGES 40.00 Anesthesiology $ 0 $ 0 0.000000 $ $ 0 41.00 Radiology - Diagnostic 0 0 0.000000 0 43.00 Radioisotope 0 0 0.000000 0 44.00 Laboratory 0 0 0.000000 0 53.00 Electrocardiology 0 0 0.000000 0 54.00 Electroencephalography 0 0 0.000000 0 61.00 Emergency 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 0 0 0.000000 0 TOTAL $ 0 $ 0 $ 0 $ 0 (To Schedule 3-2) (Adj ) (Adj ) (Adj ) REMUNERATION COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN'S REMUNERATION This is trial version www.adultpdf.com [...]...STATE OF CALIFORNIA CONTRACT SCH 1 COMPUTATION OF MEDI-CAL CONTRACT COST Provider Name: CEDARS-SINAI MEDICAL CENTER Fiscal Period Ended: JUNE 30, 2008 Provider No: HSC 30625F REPORTED 1 AUDITED Net Cost of Covered Services Rendered to Medi-Cal Patients (Contract Sch 3) $ 113,981,887 $ 106,179,067 2 Excess Reasonable Cost Over Charges (Contract Sch 2) $ 0 $ 0 3 Medi-Cal Inpatient Hospital Based Physician... 0 $ 0 7 $ 0 $ 0 4 5 Subtotal (Sum of Lines 1 through 4) 8 Total Medi-Cal Cost (Sum of Lines 5 through 7) $ 9 Medi-Cal Overpayments (Adj ) $ 0 $ 0 10 Medi-Cal Credit Balances (Adj ) $ 0 $ 0 11 $ 0 $ 0 12 $ 0 $ 0 13 TOTAL MEDI-CAL SETTLEMENT Due Provider (State) 113,981,887 $ 106,179,067 (To Summary of Findings) $ This is trial version www.adultpdf.com 0 $ (To Summary of Findings) 0 . 3-2) (Adj ) (Adj ) (Adj ) REMUNERATION COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN'S REMUNERATION This is trial version www.adultpdf.com STATE OF CALIFORNIA CONTRACT SCH. 3-1) COMPUTATION OF PROFESSIONAL COMPONENT OF HOSPITAL BASED PHYSICIAN'S REMUNERATION (Adj ) TOTAL CHARGES TO ALL PATIENTS (Adj ) HBP REMUNERATION TO CHARGES MEDI-CAL CHARGES MEDI-CAL COSTREMUNERATION RATIO. 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 SCHEDULE 3-2 PROGRAM: REHABILITATION Provider