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Audit and Reimbursement

Accelerated Payments - View reasons a provider may request an accelerated payment as well as the Provider Request for Accelerated Payment Form, Accelerated Payments Calculation, and Accelerated Payment Request Certification.

Audit - View information regarding Bad Debt, Wage Index, Diagnosis Related Group (DRG), Resource Utilization Group (RUG), Method Billing, and other financial related topics.

Cost Reports - View information on the timelines, submission requirements, mailing and contact information, requests for copies, and the Provider Statistical and Reimbursement (PS&R) system.

Credit Balance Reports - Access the CMS 838 format, Noridian's Excel spreadsheet template, Certification Page, and Details Page instructions.

Interim Rate Review - View information regarding Year-End Interim Rate reviews, timelines per provider's fiscal year end, provider types, and the Tentative Settlement (TS) review.

Overpayments - View information on Demand Letters, Immediate Offset Request, Overpayment Interest Rates, Sending Part A Overpayments Checks.

Periodic Interim Payments (PIP) - View information in regards to providers that receive bi-weekly Medicare Periodic Interim Payments (PIP).

PRRB and Hearing - Part A Providers are guaranteed the right to Appeal any "final determination" (NPR) with which they are dissatisfied, providing the issue meets specific criteria. View the Provider Reimbursement Review Board (PRRB) process as well as the Intermediary appeal hearing contact information.

Rebate Summary Letters - View information regarding rebate summary letters sent to providers to explain B2 and provider submitted check refunds found on the Remittance Advices.

Voluntary Refund/Self Disclosure Process - Providers should follow the processes defined when they feel they may have a potential self-disclosure or voluntary refund they need to complete to Medicare.

Wage Index - Access the Hospital Wage Index Development Time Table, Pension Plan Costs and workshop, and the Wage Index Prefunding Worksheet.

The following resources offer guidelines and regulations pertaining to Medicare Audit and Reimbursement.

Last Updated Apr 19, 2017