Providers participating with NMAP as RHCs must submit an annual cost report to the Department. The RHC must report and supply the Department with necessary documentation regarding, cost reports, and any other documentation when requested.
The Medicare cost report form CMS- 222-92 can be found in the Provider Reimbursement Manual-Part 2 ( Pub. 15-2), Chapter 29 located at http://www.cms.gov/maunals/PBM/list.asp on the CMS website.
Hospital-based RHCs associated with hospitals of 50 beds or greater must complete Worksheet M of Form CMS- 2552-96. Hospital and Hospital Complex Cost Report Found in provider reimbursement manual-Part 2 ( Pub. 15-2), Chapter 36, located at http://www.cms.hhs.gov/Manuals/PBM/list.asp on the CMS website.
471 Neb. Admin. Code, ch. 34, § 008