STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS_part4

STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS Page 1Schedule 8A-2Provider Name: LTC90058F 1538221288 206194113Provider Number:Provider NPI:OSHPD Facility Number:Fiscal Period: JANUARY 1, 2008 THROUGH DECEMBER 31, 2008VILLA SCALABRINITOTAL ADJ (Page 1) 10 11 12 13 14 15 16AUDIT ADJAUDIT ADJAUDIT ADJAUDIT ADJAUDIT ADJAUDIT ADJAUDIT ADJAUDIT ADJAUDIT ADJ130.00 Hospice Inpatient Care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (3,780) (872) 0 0 0 0 14,654 5,710 0 0 (14,172) 0 0 0 0 0 (14,654) (5,710) 6,687 (495) 5,710 14,654 (872) (3,780)0135.00 Other Routine Services136.00 Residential Care140.00 Beauty and Barber145.00 Other Nonreimbursable155.00 Social Services155.01...
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STATE OF CALIFORNIA ADJUSTMENTS TO REPORTED COSTS_part4