Expanded Coverage of Positron Emission Tomography (PET)Scans

TO:	All Providers
FROM:	CareFirst of Maryland, Inc. Medicare Audit & Reimbursement
DATE:	June 1, 2001
SUBJECT:	Clarification of Provider cost Report Filing Requirements

This reminder is being re-issued to clarify some filing requirements for the Form HCFA-339, Provider Cost Report Reimbursement Questionnaire, and to update several references to the cost reports. This bulletin was previously issued as an article in the Intermediary News, September 1999.

Who Should File Form HCFA-339

HCFA Pub. 15-II, Section 1100.1 requires all providers filing a full Medicare cost report to submit a properly completed Form HCFA 339 with the cost report filing. This includes not only hospitals, SNFs, CORFs, and OPTs, but also ESRDs, home offices, etc. There has been some question lately as to whether or not ESRD facilities and home offices must complete the HCFA 339, because they are not specifically listed on the first page of Exhibit 1. Not every cost report form is listed. Instead, a line for "Other" cost reports/cost statements is included on the first page.

Failure to submit a properly completed Form HCFA 339 will result in rejection of the cost report being filed. In the case of a home office, besides rejection of the cost statement, all home office costs will be eliminated from the related provider cost reports.

Expansion of Services and/or Business

All providers are to complete the attached sheet entitled "Expansion of Services and/or Business" and submit it with their Form HCFA 339. This was effective for cost reporting periods ending on or after June 30, 1998.

If you have not done so, and have any questions, please contact your assigned Medicare auditor.

Owner's/Management Personnel Compensation

PPS hospitals are not required to complete Exhibit 6, Providers Owners/Management Compensation of Form HCFA 339. However, any cost based units attached to the PPS hospital are required to complete Exhibit 6, effective for cost reporting periods ending on or after June 30, 1998.

Compensation must be reported for not more than the top 10 management personnel. The exhibit for owners and relatives is not limited to 10 individuals. All owners and relatives employed by the provider must be included in the report. This is in addition to the manager's exhibit.

Wage-Related Costs

Wage related cost reporting applies to:

PPS hospitals effective for cost reporting periods beginning on or after October 1, 1994
All skilled nursing facilities filing form HCFA-2540 for cost reporting periods beginning on or after July 1, 1995.

The following are corrections to the cost report references indicated in the form HCFA-339, dated November 1995, and later. For cost reports and form HCFA-339s already filed, this data is for reference purposes only, not requiring any action by the providers or FIs.

Form HCFA-339 Reference	HCFA Cost Report Form	Cost Report Reference
1102.3.I	2552-92	Worksheet S-3, Part III, col. 3, line 26
	2552-96	Worksheet S-3, Part II, col. 3, line 9
	2540-96	Worksheet S-3, Part II, col. 3, line 17

1102.3.P	2552-92	Worksheet S-3, Part III, col. 3, lines 28 and 29
	2552-96	Worksheet S-3, Part II, col. 3, lines 13 and 14
	2540-96	Worksheet S-3, Part II, col. 3, lines 19 and 20

Ex. 1.I.4	2552-92	Worksheet S-3, Part III, col. 3, line 26
	2552-96	Worksheet S-3, Part II, col. 3, line 9
	2540-96	Worksheet S-3, Part II, col. 3, line 17

Ex. 1.K.7	2552-92	Worksheet S-3, Part III, col. 3, line 27
	2552-96	Worksheet S-3, Part II, col. 3, lines 11 and 12
	2540-96	Worksheet S-3, Part II, col. 3, line 18

Ex. 1.P.2	2552-92	Worksheet S-3, Part III, col. 3, line 25
	2552-96	Worksheet S-3, Part II, col. 3, line 3
	2540-96	Worksheet S-3, Part II, col. 3, line 16

If you have any questions regarding the above or any other issues regarding filing Form HCFA 339, please contact your assigned Medicare auditor.

(Source: PM A-01-58, CR 429)

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Expansion of Services and/or Business

All providers are to answer the following and attach this form to the front of their submitted Form HCFA-339:

Has your facility/business purchased a physician practice or any other entity during the current cost reporting year?

If yes, have you notified your Regional Office and the fiscal intermediary?

If yes, has the state agency completed their survey and grated approval that the entity or physician practice purchased is considered provider-based?

If yes, is this included in your cost report as a provider-based entity?

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