Reimbursement
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. |
| Hospice |
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 |
| Other | |
| Fiscal Year Ending (FYE) Changes |