Interim Rate Review Process
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 60 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 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.
Last Updated May 08, 2015