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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 forms are used to provide 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 JJIRR@PalmettoGBA.com.

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