HOS Cost Report

This report can be used to complete CMS Form 1984-14 for Hospice annual cost reporting. Select the criteria you want to use to filter the report:

1. First, click the arrow beside the Offices field and then select the corresponding check box next to the specific office you wish to print a cost report for. To print a report for all offices, click the top-level check box.

2. To include all details in the report, click the Show Details check box. Otherwise, clear this check box to see a high-level report without specific details.

3. The Service From field specifies the starting date that will be used for the cost report.

4. The Service Thru field specifies the ending date that will be used for the cost report.

5. Click Preview. Depending on what browser you are using, you may see a message asking if you would like to "Open" or "Save" the file. If you select the "Save", the system prompts you name the file and select a location where you would like to save the file.

The HH Cost Report Part I report contains:

● Header information:

o Office Number

o Service Date

o Show Detail

● General Reports (2) — The Hospice Cost Report breaks the information into two main sections (Unduplicated Days and Gross Patient Revenue) then further breaks it down by Level of Care & Payer.

o Level of Care

o Medicare (Title XVIII)

o Medicaid (Title XIX)

o Other/Commercial

o Total

● Detailed Reports (2) — Additional detailed information has been included to supplement the General Report (if Show Detail was selected before generating the report), including the following columns:

o Unduplicated Days by Level of Care & Payer

§ LOC

§ Category

§ Payor

§ Office

§ Patient ID

§ Patient Name

§ Admit Date

§ LOC From

§ LOC Thru

§ Discharge Date

§ Days