Cost Report Rates - JE Part A
Cost Report Rates
Access the below information from this webpage.
Interim Rate Review
Noridian completes Interim Rate reviews on the following providers:
- Critical Access Hospital (CAH) - Part A and Part B
- CAH Swing Bed Subunit - Part A and Part B
- Rural Health Clinic (RHC) - Part B
- Children's Hospital - Part A
- Pass-through reviews
Interim rate reviews are performed based on the provider's fiscal year.
The first review is called a Year-End Interim Rate review. It is completed within 90 days after the provider's fiscal year end. Noridian reviews all the provider types listed above. Noridian mails out a letter a month prior informing the providers that a year-end review will be completed along with a provider questionnaire requesting updated information (i.e. expenses, days, and change in charge structure). The questionnaire does not apply to PPS facilities, freestanding RHCs or Children's Hospitals. The review is completed using the provider's questionnaire, the most recently submitted Cost Report (C/R), and a Provider Statistical and Reimbursement Report (PS&R) with dates of service from the beginning of the fiscal year to the end of the fiscal year.
The second review is completed at Tentative Settlement (TS), which is due 90 days after your cost report is accepted. Noridian reviews all the provider types listed above and adjusts the rates based on the Tentatively Settled C/R. Once the Tentative Settlement is completed, those rates are used along with a current PS&R to determine if a lump sum adjustment is necessary for the current year.
If a provider has an interim cost report, they may submit that in lieu of the provider questionnaire. Projected cost reports will not be accepted.
No retroactive lump sum adjustments are calculated for the year-end interim rate reviews, as over- or underpayments are not allowed after a provider's year end has passed in accordance with the CMS Internet Only Manual (IOM), Publication 100-06, Medicare Financial Management Manual, Chapter 3, Section 60. Any over- or underpayment for the fiscal year being reviewed will be incorporated into the Notice of Program Reimbursement (NPR).
A provider can request an interim rate review at any time during the year by sending in an interim cost report.
Please contact JE Reimbursement with any questions JE-Reimb@noridian.com
Periodic Interim Payments (PIP)
Institutional providers that receive bi-weekly Medicare Periodic Interim Payments (PIP) are required to maintain timely and accurate billing for program services. According to the policy as described in the CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 80.4, timely and accurate means that 85% of bills are submitted within 30 days of discharge and pass front-end edits for consistency and completeness. Medicare Administrative Contractors must measure compliance with this policy and report their findings to the affected providers. Providers that fail to meet the criteria are to be removed from PIP and paid on a claim-by-claim basis. Noridian is currently monitoring to ensure that the requirements set forth by CMS are being adhered to by PIP providers. If you have any questions, please email us at JE-Reimb@noridian.com.
Prospective Payment System (PPS) Rates
The CMS Web Pricer is a self-service tool for providers to use to estimate their Medicare Prospective Payment System (PPS) payments. Available to view through the Pricer is the Provider Directory and claim estimators by facility type.
Provider Directory
The Provider Directory allows you to view the Provider Specific File (PSF) data that is used to estimate a Medicare payment. You can access this information by selecting your facility type and provider number. You are then able to view information by different fiscal years. Rates on the Web Pricers are updated approximately every three months. If you need information about the most recent rate, and the Web Pricers have not been updated yet, you will want to get in touch with your company's System for Tracking Audit and Reimbursement (STAR) contact or the authorized official located in the Provider Enrollment, Chain, and Ownership System (PECOS) for your most recent rate letter. You can then update the Pricer with the current information through the editable fields which will locally store revisions within your browser.
Any requests for rate information submitted to audit and reimbursement staff will result in a referral to the STAR contact and the CMS Web Pricers.
Claim Estimates
You are also able to enter in claim details to estimate the Medicare PPS payment. Please note that This is an estimator and may not exactly match the payment amount determined by the Medicare claims processing system. By using this tool, you understand the limitation in estimating a claim.
If you have any questions about the CMS Web Pricer, please call our Provider Contact Center (PCC).
