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Standard Application |
Hospitals may file one of two types of Standard Application – retroactive or non-retroactive. Retroactive (rates will be effective on the first day of the hospital’s fiscal year) applications must be filed 75 days prior to the beginning of the fiscal year and non-retroactive applications must be filed 45 days prior to the beginning of the fiscal year. When submitting a standard application, each of the following must be completed:
| Checklist | ||||
| CBM 1 | IP Discharges | Instructions | ||
| CBM 1A | IP Days | Instructions | ||
| CBM 1B | OP Visits | Instructions | ||
| CBM 1C | Beds and Occupancy | Instructions | ||
| CBM 2 | Gross IP Revenue | Instructions | ||
| CBM 2A | Gross OP Revenue | Instructions | ||
| CBM 3 | Wage and Salary | (Total, Acute) | Instructions | |
| CBM 4 | Operating Expenses | (Total,Acute,DPU) | Instructions | |
| CBM 5 | Revenue and Expenses | (Total,Acute,DPU) | Instructions | |
| CBM 6 | Balance Sheet | |||
| CBM 9 | Monitor and Variance | Instructions | ||
| CBM RO | Related Organizations | Instructions | ||
| CBM DC | Discount Contracts | (prj and budget) | Instructions | |
| CBM DCL | Discount Contract List | (prj and budget) |