Reimbursement

Published 03/02/2021

The Reimbursement department is responsible for reviewing and setting payment rates for Part A providers. This includes reviewing financial data and ensuring the FISS Provider Specific File is properly maintained, performing tentative settlements, reviewing provider-based designation requests and hospital low volume adjustment requests. In addition to accurately reimbursing providers, the reimbursement team is also responsible for receiving and accepting Medicare cost reports.

Cost Report Filing

Medicare cost reports are typically due five months after the fiscal year end. If a cost report is not filed timely, payment will be suspended until the cost report is filed and determined to be acceptable. The MAC has 30 days to accept cost report from date of receipt.

Tentative Settlements Tentative Settlements are required by CMS to be completed within 90 days of acceptance of the cost report. 

Interim Rate Reviews (IRR)

Perform at a minimum two reviews per year. Typical review occurs at the 4th and 8th month of the provider’s FYE. 

Periodic Interim Payments (PIP)  PIP Reviews occur three times per year. 

Provider Statistical and Reimbursement (PSR)

CMS has made the PSR system available to providers. Providers must attempt to request the PSR prior to requesting assistance from the MAC.

Other
Fiscal Year Ending (FYE) Changes
Low Volume Adjustment (LVA) Requests