Get 10 96 Form

The 10 96 Form is essential for reporting patient revenues and operating revenues for healthcare providers. This guide will provide you with step-by-step instructions on how to complete this form online effectively and accurately.

Follow the steps to fill out the 10 96 Form online.

1. Click the ‘Get Form’ button to access the 10 96 Form in the interactive editor.
2. Identify the 'Provider No.' and the 'Period' fields at the top of the form, and enter the relevant details for your reporting period.
3. Proceed to Part I - Patient Revenues. Here, you will fill out different types of revenues, including inpatient and outpatient totals. For each category, accurately input the corresponding revenue figures.
4. Under the revenue center section, list all applicable services. Ensure to include general inpatient routine care services and intensive care type inpatient hospital services as specified.
5. Continue filling in all other ancillary services and outpatient services as required in the form. Make sure to sum up the total patient revenues and transfer this amount to Worksheet G-3.
6. Move on to Part II - Operating Expenses. Here, enter operating expenses as referenced in Worksheet A. Specify any additions or deductions, and ensure to sum these correctly.
7. Calculate the total operating expenses. This total should reflect your total revenues minus any deductions you've recorded. Transfer this amount to Worksheet G-3.
8. Once all fields are completed, review for accuracy. To conclude, save your changes, then download, print, or share the completed form as needed.

Start filling out your 10 96 Form online today!