Interim Rate Review Documentation
Published 12/21/2020
To reimburse providers as accurately as possible, we are requesting current year information to use in setting payment rates. This would include current year information on items such as bad debts, other costs and statistics. As well, we are requesting information on factors that could impact Medicare reimbursement, such as changes in service or changes in Medicare utilization.
The following are the forms to use in providing this current information.
- Interim Rate Review Documentation Request — Acute Care Hospital (XLXS, 18 KB)
- Interim Rate Review Documentation Request — Critical Access Hospital (XLXS, 18 KB)
- Interim Rate Review Documentation Request — Long Term Care Hospital (XLXS, 16 KB)
- Interim Rate Review Documentation Request — Psychiatric Hospital or Subunit (XLXS, 16 KB)
- Interim Rate Review Documentation Request — Rehabilitation Hospital or Subunit (XLXS, 16 KB)
- Interim Rate Review Documentation Request — Skilled Nursing Facility (XLXS, 15 KB)
This information can be emailed to jmreimbursement@palmettogba.com or mailed to:
Reimbursement Manager
Provider Reimbursement
Mail Code: AG-330
Palmetto GBA
PO Box 100144
Columbia, SC 29202-3144