October 1, 2018
WinLASH 222-17 for the Rural Health Clinic Medicare Cost Report has been approved by CMS for Transmittal 1. CMS Form 222-17 replaces 222-94. It is effective for Cost Reporting Periods ending on or after 9/30/2018.
These new instructions and forms must be filed by freestanding RHCs and RHCs previously reported as part of a Skilled Nursing Facility (SNF) complex or Home Health Agency (HHA) complex. RHCs that are part of a hospital healthcare complex must use the Form CMS-2552-10.
View WinLASH 222 approval letter.
Download the latest version of WinLASH 222 here.
Below is a summary of the cost reporting forms.
Worksheet S, Parts I, II & III, provides the cost report status/certification statement and settlement summary.
Worksheet S-1, Part I, provides RHC identification data.
Worksheet S-1, Part II, collects data for each RHC that files as part of a consolidated cost report.
Worksheet S-2, incorporates data previously reported on the Provider Cost Report Reimbursement Questionnaire, Form CMS-339.
Worksheet S-3, Part I, collects statistical data regarding the number and types of visits by title, as well as, the number of visits performed by interns and residents.
Worksheet A separately identifies general service and direct patient care costs.
Worksheet B, Part I & II, calculates visits and productivity standard and allowable costs of RHC services.
Worksheet C, Part I & II, calculates the adjusted rate per visit and the determination of the total payment.
Worksheet B-1 computes pneumococcal and influenza vaccine costs.
Worksheet C-1, provides an analysis of payments to the RHC for services rendered.