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