Audit and Reimbursement
Medicare Audit and Reimbursement is divided among three distinct areas: reimbursement, audit, and cost reports. The primary functions of the Medicare Audit and Reimbursement Unit are:
- Assure final payments to providers are in accordance with Medicare laws, regulations and instructions
- Verify financial and statistical information contained in the Medicare cost report
- Arrive at a correct program reimbursement. In so doing, preserve the provider's interests and rights but at the same time apply program policies to specific situations to ensure compliance with these policies.
Audit and Reimbursement Contact Information
MCReF — Website: https://mcref.cms.gov
Providers can access this portal and receive important information, including NPR settlement packages, rate review letters, tentative and lump sum payment notifications, etc.
We encourage providers to sign up for an MCReF account and review the information provided before submitting any questions to the MAC.
eServices
For submission of documents to our audit, reimbursement, or wage index teams. Please ensure you select the proper dropdown, so the information travels to the correct area.
Provider Contact Center (PCC)
Jurisdiction J (JJ): 877–567–7271
Jurisdiction M (JM): 855–696–0705
- Underpayment, overpayment, or withholding questions
- Check/payment receipt inquiries
- EFT requests or applications
Acceptance — Email: STAR@palmettogba.com
- Acceptance or rtejection of cost reports
- Contact information updates (name/email only, and only for A&R)
- Consolidation requests
- Cost report extension inquiries
- Provider contact updates (see also the contact update form HERE)
Please do not send address updates Tthese must be sent through the CMS-855A form to enrollment. Note: Providers can sign up for and access the PS&R system to retrieve summary PS&R requests themselves at the link: https://psr-ui.cms.hhs.gov/psr-ui.
Reimbursement
JJ Email: JJIRR@palmettogba.com
JM Email: JMReimbursement@palmettogba.com
- Tentative/lump sum/passthrough inquiries
- Per Resident Amount inquiries
- Hospital Specific Rate calculations
- Provider-based determinations
- Low Volume Adjustments
- RRC/SCH/MDH status/supporting documentation requests
- Interim Rate Review inquiries
- RHC productivity exemption requests
- New HITECH payment requests
Audit
JJ Email: JJCostReport@palmettogba.com
JM Email: JMCostReport@palmettogba.com
- Questions regarding the treatment of reimbursable areas reported on the cost report
- Questions regarding desk review/audit adjustments if your assigned auditor cannot be reached
- GME Affiliation Agreements
- Stat basis change requests
Please do not send questions regarding collection of overpayment, withholdings, repayment requests or issuance of checks. These questions would be directed to our finance department. Please call the PCC at 877–567–7271.
Wage Index
JJ Email: JJWageIndex@palmettogba.com
JM Email: CostReport.WageIndex@palmettogba.com
- Submissions of support for wage index or OMS
- Questions regarding wage index allowability
- Questions regarding OMS allowability
Please do not send questions regarding wage index rates published by Center for Medicare & Medicaid Services (CMS). Audit only reviews but has no bearing on CMS' actual wage index calculation after our reviews are completed. These inquiries would be directed to CMS at WageIndex@cms.hhs.gov.
S-10
JJ Email: JJS10@palmettogba.com
JM Email: JMS10@palmettogba.com
Submissions of support for S10 reviews and audits.
Reopenings
JJ Email: JJAudit.Reopening@palmettogba.com
JM Email: JMAudit.Reopening@palmettogba.com
- Questions related to currently open NORs
- Requests for new provider-initiated NORs (all supporting documentation must be submitted with request)
- Volume Decrease Adjustment (VDA) requests
Appeals
JJ Email: JJAudit.Appeal@palmettogba.com
JM Email: NGSCostReportAppeal2@anthem.com *
*NGS is the point of contact for Palmetto JM cost report appeals.
- Questions regarding currently open appeals
- Requests for new appeals (all supporting documentation must be submitted with request)
MAILING INFORMATION
To mail hard copy desk review/audit support (overnight) — JJ:
Palmetto GBA
Attn: JJ Medicare Audit (AG-390)
2300 Springdale Drive, Building One
Camden, SC 29020-1728
To mail hard copy desk review/audit support (overnight) — JM:
Palmetto GBA
Attn: JM Medicare Audit (AG-320)
2300 Springdale Drive, Building One
Camden, SC 29020-1728
To mail hard copy desk review/audit support (Regular U.S. Mail) — JJ:
Palmetto GBA
Attn: JJ Medicare Audit (AG-390)
P.O. Box 100312
Columbia, SC 29202-3312
To mail hard copy desk review/audit support (Regular U.S. Mail) — JM:
Palmetto GBA
Attn: JM Medicare Audit (AG-320)
P.O. Box 100144
Columbia, SC 29202-3144
To mail a check (overnight) — JJ:
Palmetto GBA
Attn: JJ Medicare Finance (AG-260)
2300 Springdale Drive, Building One
Camden, SC 29020-1728
To mail a check (Regular U.S. Mail) — JJ:
Palmetto GBA, LLC
Attn: JJ Medicare Finance (AG-260)
P.O. Box 100312
Columbia, SC 29202-3312
To mail a check (overnight) — JM:
Palmetto GBA
Attn: JM Medicare Finance (AG-260)
2300 Springdale Drive, Building One
Camden, SC 29020-1728
To mail a check (Regular U.S. Mail) — JM:
Palmetto GBA, LLC
Attn: JM Medicare Finance (AG-260)
P.O. Box 100277
Columbia, SC 29202-3312
To mail hard copy reopening support (overnight) — JJ:
Palmetto GBA, LLC
Attn: Cost Report Reopenings, JJ (AG-390)
2300 Springdale Drive, Building One
Camden, SC 29020-1728
To mail hard copy reopening support (overnight) — JM:
Palmetto GBA
Attn: Cost Report Reopenings, JM (AG-380)
2300 Springdale Drive, Building One
Camden, SC 29020-1728
To mail hard copy reopening support (Regular U.S. Mail) — JJ:
Palmetto GBA, LLC
Attn: Cost Report Reopenings, JJ (AG-390)
P.O. Box 100307
Columbia, SC 29202-3307
To mail hard copy reopening support (Regular U.S. Mail) — JM:
Palmetto GBA
Attn: Cost Report Reopenings, JM (AG-380)
P.O. Box 100144
Columbia, SC 29202-3144
Miscellaneous Contacts
Audit mailboxes frequently receive questions that need to be routed to other departments. Please contact the below areas if your question is outside of audit and related to claims, enrollment, etc:
Enrollment
Email: PartA.Enrollment@palmettogba.com
Questions regarding form 855A, physical address changes, or any other enrollment issues or concerns.
Credit Balance
JJ Email: JJCredit.Balance@palmettogba.com
JM Email: Credit.Balance@palmettogba.com
Credit balance report inquiries. Note: The credit balance reporting tool is available as well for lookup of submitted information.
FOIA (Freedom of Information Act)
Email: FOIA@palmettogba.com
Freedom of Information Act requests. Any documentation request that is not related to a file currently being processed by audit.
Payment File Development Contractor (PFDC)
Phone: 855–223–1343
HITECH payment inquiries.