Since 1966, Medicare has
required all health care
providers to allocate the costs
of service departments to revenue
producing departments.
The Medicare cost report
requires that health care
providers use the step-down
(sequential) method or the
double-apportionment
method (which is a two-stage
variation of the step-down
method) to calculate operating
costs for patient care
departments. Health care
organizations rarely use the
direct method because service
departments provide many
services to other departments
and because the direct
method is not allowed on
Medicare cost reports. The
Medicare guideline for the
step-down method requires
that the order of the
sequence be from the service
center that renders the greatest
service to the least. The
magnitude of service is determined
by the number of
other centers served. If two
centers render service to an
equal number of centers,
then the center with the
greatest amount of expense
is allocated first. ■
Source: Provider Reimbursement Manual:
Part I, Chapter 23, http://www.cms.hhs.gov,
accessed March 2006.