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 part4 pdf
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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
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REPORT
ON THE
COST REPORT REVIEW
CENTINELA HOSPITAL MEDICAL CENTER
INGLEWOOD...
... SERVICES
COMPUTATION OF
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STATE OF CALIFORNIA CONTRACT SCH 4B
Provider Name: Fiscal Period Ended:
CENTINELA HOSPITAL MEDICAL CENTER DECEMBER 31, 2008
Provider No:
HSC30240H
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STATE OF CALIFORNIA SCHEDULE 5
PROGRAM: NONCONTRACT
Provider Name: Fiscal Period Ended:
CENTINELA HOSPITAL MEDICAL...
... Transitional Care Unit 000000000000
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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
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STATE OF CALIFORNIA SCHEDULE 8
Provider Name: Fiscal Period Ended:
CENTINELA H...
... 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
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STATE OF CALIFORNIA SCHEDULE 10A
Page 1
Provider Name: Fiscal Period Ended:
CENTINELA HOSPITAL MEDICAL CENTE...
... 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 ... Adjustments
FEBRUARY 1, 2008 THROUGH DECEMBER 31, 2008 HSC30240H
Cost Report
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State of California Department...
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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
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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...
... Adjustments
JULY 1, 2008 THROUGH JUNE 30, 2009 HSC00228W
Cost Report
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS SCHEDULE 10A
Page 1
Provider Name: Fiscal Period ... 15,900,440 *
To adjust the provider& apos;s reclassification of medical supplies charged
to patients to agree with the supporting documentations.
CMS Pub...
... 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...