Helpful tips to expedite cost report tentative settlements – worksheet E-1, Part I

To expedite receiving tentative settlement payments, record provider payments and receivables correctly in Worksheet E-1 Part I.

1. Line 3 - Enter amount of each lump sum adjustment and the applicable date.
2. Line 5 - If Worksheet S, Part I, Line 5, is “5” (Amended Cost Report), the provider should complete the remainder of worksheet E-1 Lines 5 through 8. (Prior tentative and as-filed submitted checks go here.)

See below for full details for all lines:

Form CMS-2552-10 Worksheet E-1 Part I - ANALYSIS OF PAYMENTS TO PROVIDERS FOR SERVICES RENDERED

Line 3 – Enter amount of each lump sum adjustment and the applicable date. 

• These are the interim payments made within the fiscal year.
• Enter the amount and date of each lump sum adjustment.
  
  • The payments must be recorded separately and never summed.
• Ensure adjustments are applied to Part A or Part B columns correctly.
• Lines 3.01 and subscripts are where Adjustments to Provider are recorded.
  
  • Medicare payment to provider
• Lines 3.50 and subscripts are where Adjustments to Program are recorded.
  
  • Provider payment to Medicare

Line 5 - If worksheet S, Part I, Line 5, is “5” (Amended Cost Report), the provider should complete the remainder of worksheet E-1 Lines 5 through 8.

• These are the Tentative Payments made after fiscal year end on prior submitted cost reports.
• Enter the amount and date of each tentative settlement.
  
  • The payments must be recorded separately and never summed.
• Ensure tentative settlements are applied to Part A or Part B columns correctly
• Lines 5.01 and subscripts are where Tentative to Provider are recorded.
  
  • Medicare payment to provider
• Lines 5.50 and subscripts are where Tentative to Program are recorded.
  
  • Provider payment to Medicare
  • As-filed submitted checks go here.