[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-detail-303993-en":53,"doc-seo-303993-105":76},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":5,"data":54},{"doc_id":55,"user_id":56,"nickname":57,"user_avatar":58,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":60,"doc_content":61,"file_id":62,"file_url":63,"file_type":64,"file_size":65,"view_count":66,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":67,"language":68,"language_code":69,"site_id":70,"html_lang":69,"table_of_contents":71,"faqs":72,"seo_title":73,"seo_description":60,"update_tm":74,"read_time":75},303993,687197100911,"Himbo","https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","CHAPTER 33 - ORGAN PROCUREMENT ORGANIZATION AND TISSUE TYPING LABORATORY COST REPORT - FORM CMS-216-94","Chapter 33 outlines reporting requirements for independent organ procurement organizations (OPOs) and independent histocompatibility laboratories, specifying that Form CMS-216-94 must be submitted for cost reporting periods ending on or after December 31, 1994. It explains when substitute forms may be used with advance approval, how to structure required worksheets and certification components, and which worksheets to bypass when limited to kidney procurement functions or to tissue-only typing tests. It also provides guidance for allocating overhead and handling acquired organ types, including offsetting certain tissue-related income against specified coordinator costs.","CHAPTER 33  \nORGAN PROCUREMENT ORGANIZATION  \nAND TISSUE TYPING LABORATORY  \nCOST REPORT  \nFORM CMS-216-94  \nSection  \nGeneral .................................................................................................................3300  \nRecommended Sequence for Completing OPO/LAB Cost Report .....................3301  \nWorksheet S-Organ Procurement Organization/ Histocompatibility Laboratory General Data and Certification Statement .....................................................................................3302  \nPart I-General ...............................................................................................3302. 1  \nPart II-Certification By Officer or Administrator ........................................3302.2  \nPart III – Settlement Summary ......................................................................3302.3  \nWorksheet S-1-Organ Procurement Organization/ Histocompatibility Laboratory Identification Data ...........................................3303  \nPart I-OPO Statistics ....................................................................................3303. 1  \nPart II-Lab Statistics ....................................................................................3303.2  \nPart III-Full Time Equivalent Employees (FTEs) .......................................3303.3  \nWorksheet A-Reclassification and Adjustment of Trial Balance of Expenses .........................................................................................3304  \nWorksheet A-1-Administrative and General Expenses .....................................3305  \nWorksheet A-2-Organ Acquisition Costs ..........................................................3306  \nWorksheet A-3-Tissue Typing Laboratory Costs ..............................................3307  \nWorksheet A-4-Reclassifications.......................................................................3308  \nWorksheet A-5-Adjustments to Expenses .........................................................3309  \nWorksheet A-6-Capital Expenditures and Depreciation Reconciliation ...................................................................................................3310  \nWorksheet B-Cost Allocation-General Service Costs and Worksheet B-1-Cost Allocation-Statistical Basis ..................................................................................................................3311  \nWorksheet C-Computation of Medicare Cost....................................................3312  \nWorksheet D-Calculation of Reimbursement Settlement ..................................3313  \nWorksheet E-Balance Sheet...............................................................................3314  \nWorksheet E-1-Statement of Operating Expenses and Revenues ...........................................................................................................3315  \nWorksheet E-2-Statement of Revenues and Expenses ......................................3316  \nSupplemental Worksheet A-5-1-Statement of Costs of Services From Related Organizations ...............................................................3317  \nKidney Placement Efforts-Documentation Requirements .................................3318  \nExhibit 1-Form CMS-216-94 Worksheets .........................................................3390  \nElectronic Reporting Specifications for Form CMS-216-94 ............................ 3395  \n3300. GENERAL  \nAll independent organ procurement organizations (OPOs) and independent histocompatibility laboratories (Labs) must submit Form CMS-216-94 for cost reporting periods ending on or after December 31, 1994. Substitute forms may be used with advance approval from the intermediary and the Centers for Medicare and Medicaid Services (CMS) . Substitute forms must contain all information and data required by the standard form. Use Form CMS-216-94 unless advance approval is obtained.  \nForm CMS-216-94 is used for the following cost reports:  \no Independent organ proc","cbCaifaI4B536lcz","https://ap.wps.com/l/cbCaifaI4B536lcz","pdf",363613,6,67,"English","en",105,"# General\n## Recommended Sequence for Completing OPO/LAB Cost Report\n## Worksheet S-Organ Procurement Organization/Histocompatibility Laboratory General Data and Certification Statement\n## Worksheet S-1-Organ Procurement Organization/Histocompatibility Laboratory Identification Data\n## Worksheet A-Reclassification and Adjustment of Trial Balance of Expenses\n## Worksheet B-Cost Allocation\n## Worksheet C-Computation of Medicare Cost\n## Worksheet D-Calculation of Reimbursement Settlement\n## Worksheet E-Balance Sheet\n## Supplemental Worksheet A-5-1-Statement of Costs of Services From Related Organizations\n## Kidney Placement Efforts - Documentation Requirements\n## Exhibit 1-Form CMS-216-94 Worksheets\n## Electronic Reporting Specifications for Form CMS-216-94","[{\"question\":\"Who must submit Form CMS-216-94 for cost reporting?\",\"answer\":\"All independent organ procurement organizations (OPOs) and independent histocompatibility laboratories must submit Form CMS-216-94 for cost reporting periods ending on or after December 31, 1994.\"},{\"question\":\"When can substitute forms be used instead of Form CMS-216-94?\",\"answer\":\"Substitute forms may be used only with advance approval from the intermediary and CMS, and they must include all required information and data.\"},{\"question\":\"Which worksheets can be bypassed for kidney-only OPO activities or tissue-only lab typing?\",\"answer\":\"If an OPO performs kidney procurement functions only with no other associated costs, bypass Worksheets B and B-1 and flow costs from Worksheet A to Worksheet C. If a lab performs only tissue typing tests with no organ procurement or other overhead-requiring activities, bypass Worksheets B and B-1 and flow costs directly from Worksheet A to the reimbursement calculation for tissue typing on Worksheet C.\"}]","CHAPTER 33 - ORGAN PROCUREMENT ORGANIZATION AND TISSUE TYPING LABORATORY COST REPORT - FORM CMS-216-94 | PDF",1789808784,23,{"code":4,"msg":77,"data":78},"ok",{"site_id":70,"language":69,"slug":79,"title":59,"keywords":80,"description":60,"schema_data":81,"social_meta":137,"head_meta":139,"extra_data":141,"updated_unix":142},"chapter-33-organ-procurement-organization-and-tissue-typing-laboratory-cost-report-form-cms-216-94","",{"@graph":82,"@context":136},[83,99,119],{"@type":84,"itemListElement":85},"BreadcrumbList",[86,90,93,96],{"item":87,"name":88,"@type":89,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":91,"name":10,"@type":89,"position":92},"https://docshare.wps.com/template/",2,{"item":94,"name":36,"@type":89,"position":95},"https://docshare.wps.com/template/forms/",3,{"item":97,"name":59,"@type":89,"position":98},"https://docshare.wps.com/template/chapter-33-organ-procurement-organization-and-tissue-typing-laboratory-cost-report-form-cms-216-94/303993/",4,{"url":97,"name":59,"@type":100,"image":101,"author":106,"headline":59,"publisher":108,"fileFormat":111,"inLanguage":69,"description":60,"dateModified":112,"datePublished":113,"encodingFormat":111,"isAccessibleForFree":114,"interactionStatistic":115},"DigitalDocument",{"url":102,"@type":103,"width":104,"height":105},"https://docshare.wps.com/thumbnails/chapter-33-organ-procurement-organization-and-tissue-typing-laboratory-cost-report-form-cms-216-94/303993.png","ImageObject",442,249,{"name":57,"@type":107},"Person",{"url":87,"name":109,"@type":110},"DocShare","Organization","application/pdf","2026-10-02","2026-09-19",true,{"@type":116,"interactionType":117,"userInteractionCount":66},"InteractionCounter",{"@type":118},"ViewAction",{"@type":120,"mainEntity":121},"FAQPage",[122,128,132],{"name":123,"@type":124,"acceptedAnswer":125},"Who must submit Form CMS-216-94 for cost reporting?","Question",{"text":126,"@type":127},"All independent organ procurement organizations (OPOs) and independent histocompatibility laboratories must submit Form CMS-216-94 for cost reporting periods ending on or after December 31, 1994.","Answer",{"name":129,"@type":124,"acceptedAnswer":130},"When can substitute forms be used instead of Form CMS-216-94?",{"text":131,"@type":127},"Substitute forms may be used only with advance approval from the intermediary and CMS, and they must include all required information and data.",{"name":133,"@type":124,"acceptedAnswer":134},"Which worksheets can be bypassed for kidney-only OPO activities or tissue-only lab typing?",{"text":135,"@type":127},"If an OPO performs kidney procurement functions only with no other associated costs, bypass Worksheets B and B-1 and flow costs from Worksheet A to Worksheet C. If a lab performs only tissue typing tests with no organ procurement or other overhead-requiring activities, bypass Worksheets B and B-1 and flow costs directly from Worksheet A to the reimbursement calculation for tissue typing on Worksheet C.","https://schema.org",{"og:url":97,"og:type":138,"og:title":59,"og:site_name":109,"og:description":60},"article",{"robots":140,"canonical":97},"index,follow",{"doc_id":55,"site_id":70},1790729793]