Published 05/02/2023

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. 

Hospices are required to file a self-determined cap no earlier than three months after, and no later than five months after the end of the hospice cap year, September 30. The earliest a hospice may file its self-determined cap is December 31, and the latest is February 28 of each year

Fiscal Year Ending (FYE) Changes


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