Form B-6 "New Jersey Acute Care Hospitals Cost Reports - Outpatient Volumes by Payer and Outpatient Area" - New Jersey

What Is Form B-6?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download Form B-6 "New Jersey Acute Care Hospitals Cost Reports - Outpatient Volumes by Payer and Outpatient Area" - New Jersey

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NEW JERSEY ACUTE CARE HOSPITALS
B-6
2020
Hospital: __________________________________________
COST REPORTS
OUTPATIENT VOLUMES BY PAYER
Do not change any preprinted
Hospital Number: |_____|_____|_____|_____|
wording on this form.
AND OUTPATIENT AREA
A
B
C
D
E
F
G
H
I
J
K
L
Emer-
Off-Site
Outpat.
Out-
Home
(1)
Payer
Same Day
Private
Same Day
Other
TOTAL
gency
Health
Clinics
Dialysis
Patient
Dialysis
MICU
Surgery
Referred
Psych.
MICU
(1)
Room
Services
Service
Surgery
Service
1
Horizon Blue Cross of N.J. (Indemnity)
2
Other Blue Cross (Indemnity)
3
Medicare
(2)
4
Medicaid
(2)
5
CHAMPUS
6
HMO
7
Medicare HMO
8
Medicaid HMO
(3)
9
Commercial Insurers
10
Charity Care
11
Self-Pay
12
Others
13
Personnel Health
(4)
14
Totals, Net of Admissions
15
Gross Visits/Runs
16
Admitted
17
Visits, Net of Admissions
(4)
18
Primary Care Visits
(5)
(5)
19
Non-Primary Care Visits
FOOTNOTES:
(1)
Lines 1 through 13 are to be reported as net of admissions.
(2)
Do not include HMO outpatient volume data on lines 3 and 4.
(3)
Include indemnity (other than Blue Cross), and non-HMO managed care (e.g., preferred provider organizations; non-HMO point-of-service plans) on line 9.
(4)
Line 14 should agree with line 17.
(5)
Lines 18 and 19, Column B should agree with Line 17, Column B. Emergency room patients categorized as primary care shall be defined as those requiring either minimal, brief or limited
service. Non-Primary care patients are those patients requiring intermediate, extended or comprehensive service.
NEW JERSEY ACUTE CARE HOSPITALS
B-6
2020
Hospital: __________________________________________
COST REPORTS
OUTPATIENT VOLUMES BY PAYER
Do not change any preprinted
Hospital Number: |_____|_____|_____|_____|
wording on this form.
AND OUTPATIENT AREA
A
B
C
D
E
F
G
H
I
J
K
L
Emer-
Off-Site
Outpat.
Out-
Home
(1)
Payer
Same Day
Private
Same Day
Other
TOTAL
gency
Health
Clinics
Dialysis
Patient
Dialysis
MICU
Surgery
Referred
Psych.
MICU
(1)
Room
Services
Service
Surgery
Service
1
Horizon Blue Cross of N.J. (Indemnity)
2
Other Blue Cross (Indemnity)
3
Medicare
(2)
4
Medicaid
(2)
5
CHAMPUS
6
HMO
7
Medicare HMO
8
Medicaid HMO
(3)
9
Commercial Insurers
10
Charity Care
11
Self-Pay
12
Others
13
Personnel Health
(4)
14
Totals, Net of Admissions
15
Gross Visits/Runs
16
Admitted
17
Visits, Net of Admissions
(4)
18
Primary Care Visits
(5)
(5)
19
Non-Primary Care Visits
FOOTNOTES:
(1)
Lines 1 through 13 are to be reported as net of admissions.
(2)
Do not include HMO outpatient volume data on lines 3 and 4.
(3)
Include indemnity (other than Blue Cross), and non-HMO managed care (e.g., preferred provider organizations; non-HMO point-of-service plans) on line 9.
(4)
Line 14 should agree with line 17.
(5)
Lines 18 and 19, Column B should agree with Line 17, Column B. Emergency room patients categorized as primary care shall be defined as those requiring either minimal, brief or limited
service. Non-Primary care patients are those patients requiring intermediate, extended or comprehensive service.