Audit and Reimbursement
Noridian's Audit and Reimbursement team assists Part A providers perform a variety of financial activities.
Information regarding Bad Debt, Wage Index, Diagnosis Related Group (DRG), Resource Utilization Group (RUG), Method Billing, and other financial related topics are provided.
The 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 are provided.
Includes information on the timelines, submission requirements, mailing and contact information, requests for copies, and the Provider Statistical and Reimbursement (PS&R) system.
Access to the CMS 838 format, Noridian's Excel spreadsheet template, Certification Page, and Details Page instructions are provided.
Information regarding Year-End Interim Rate reviews, timelines per provider's fiscal year end, provider types, and the Tentative Settlement (TS) review is provided,
View information on the following:
This webpage provides information in regards to providers that receive bi-weekly Medicare Periodic Interim Payments (PIP)
Part A Providers are guaranteed the right to Appeal any "final determination" (NPR) with which they are dissatisfied, providing the issue meets specific criteria. This page describes the Provider Reimbursement Review Board (PRRB) process as well as the Intermediary appeal hearing contact information.
|Rebate Summary Letters||Information regarding rebate summary letters sent to providers to explain B2 and provider submitted check refunds found on the remittance advices.|
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.
Access the Hospital Wage Index Development Time Table, Pension Plan Costs and workshop, and the Wage Index Prefunding Worksheet within this webpage.
The following resources offer guidelines and regulations pertaining to Medicare Audit and Reimbursement.
- CMS Homepage
- CMS Regulations and Guidance
- HIPAA Information
- The Provider Reimbursement Manual (PRM) I
- The Provider Reimbursement Manual (PRM) II
- CMS Internet Only Manuals (IOMs)
- CMS Manuals Page
- CMS Transmittals
Last Updated Oct 04, 2016