Home
Forms Library
Form DOH-4274 - Nursing Home Cash Receipts Report Cash Receipts Assessment Program - health ny

Form DOH-4274 - Nursing Home Cash Receipts Report Cash Receipts Assessment Program - health ny-2025

Form DOH-4274 - Nursing Home Cash Receipts Report Cash Receipts Assessment Program - health ny Preview on Page 1

See details

4.6 out of 5

64 votes

The document is a Health Facility Cash Receipts Assessment Report from the New York State Department of Health, covering the period from April 1, 2003, to March 31, 2005. It outlines the cash receipts from patient care services and other sources for health facilities, detailing assessable and non-assessable cash receipts. The report includes instructions for payment and adjustments related to the assessment.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Form DOH-4274 - Nursing Home Cash Receipts Report Cash Receipts Assessment Program - health ny with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering the month and year for which you are reporting in the designated field at the top of the form.
Fill in your provider name, operating certificate number, and MMIS number in the respective fields to ensure proper identification.
In Section A, report cash from patient care services and any other cash receipts. Ensure that all amounts are entered in whole dollars only.
Calculate total cash receipts from all sources by adding lines 1 and 3. Deduct non-assessable cash receipts as specified in Schedule A.
Determine assessable cash receipts by subtracting line 5 from line 4. Apply the assessment rate to calculate the current month assessment on line 8.
Include any other adjustments on line 9 and sum them with line 8 to find the total amount due on line 10.
Finally, review all entries for accuracy before saving or printing your completed form for submission.

Start using our platform today to streamline your form completion process for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is evidence of cash receipt?

A cash receipt is a document that shows evidence of a cash transaction. It should show the specific amount transferred between the parties and an itemized list of goods and services provided.

What is NYS cash receipt assessment?

HFCAP requires New York State designated providers to pay an assessment on cash operating receipts on a monthly basis under the Health Facility Cash Receipts Assessment Program pursuant to Chapter 1 of the Laws of 2002 as amended by various subsequent period Chapter Laws.

What is the assessment rate for nursing homes in NY?

The HFCAP assessment rate for Nursing Homes currently 6.8% has been extended to March 31, 2025.

What is the meaning of cash assessment?

The Comprehensive Assessment and Social History (CASH) is designed to provide a comprehensive picture of the member and to meet the requirements outlined in the Health Home State Plan Amendments, Person-Centered Planning practices, the National Committee on Quality Assurance LTSS Standards, and Iowa Administrative Code

What is the purpose of a cash receipt?

A cash receipt is an accounting entry that documents the collection of cash from a customer. Cash receipts typically increase (debits) the companys cash balance on its balance sheet. Simultaneously, they decrease (credits) either accounts receivable or another asset account.