2007-2008 Occupational Mix Survey Hospital Reporting Form (Form CMS-10079 (2008))

Section 304(c) of Public Law 106-554 amended section 1886(d)(3)(E) of the Social Security Act and requires CMS to collect data every 3 years on occupational mix of employees for each short-term, acute care hospital participating in the Medicare program. The zip file in the downloads section below contains two files. One is a PDF document which contains Form CMS-10079 (2008) and includes the 2007-2008 Occupational Mix survey HOSPITAL form and instructions and definitions. The second file is an excel spreadsheet that has two tabs: One is the 2007-2008 Occupational Mix survey form that HOSPITALS MUST complete and submit to their Fiscal Intermediary or A/B Medicare Administrative Contractor. The second tab contains the 2007-2008 Occupational Mix survey hospital instructions and definitions. CMS requires that hospitals use the excel spreadsheet when hospitals submit their 2007-2008 Occupational Mix survey data to their Fiscal Intermediary or A/B Medicare Administrative Contractor. Also included in this zip file are the relevant text files in order to meet 508 compliance.