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