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Last Modified: 12/4/2018 Location: FL, PR, USVI Business: Part A

Cost report reopenings

In accordance with the instructions contained in 42 Code of Federal Regulations (CFR) 405.1885 and the Provider Reimbursement Manual ( PRM) 15-1, chapter 29, sections 2931 through 2932 compressed file, a cost report may be reopened if a written request to reopen is received within three years from the date that the Notice of Amount of Program Reimbursement (NPR) was issued. A cost report reopening may be initiated by:
The provider within three years from the date that the NPR was issued,
The Centers for Medicare & Medicaid Services (CMS), or
The Medicare administrative contractor (MAC), where it is:
Initiated by the audit branch from a directive from CMS via a finding from the peer review process or other event.
Initiated by the appeals unit from findings from CMS or the Office of the Inspector General (OIG).
Initiated by the final settlement unit where there is a material error in subsequent payments.
However, if fraud or similar fault is involved, First Coast Service Options Inc., (First Coast) can reopen the cost report at any time.
All provider-initiated reopening requests must contain proper supporting documentation, as noted in PRM 15-1, chapter 29, section 2931.2 compressed file, include the reimbursement impact and besubmitted in writing via the preferred method the SPOT portal. It may also be submitted by mail postal/overnight carrier addressed to the Jacksonville office:
Debbie Paul, Director Provider Audit-JN
First Coast Service Options-Provider Audit & Reimbursement
532 Riverside Avenue
Jacksonville, FL 32202
The responsible audit manager will:
1. Determine whether or not the reopening request is timely and,
2. Mail an acknowledgement letter to the provider.
Also, if after the provider supplies the requested documentation, and the audit manager determines that the provider's documentation is sufficient, a “Notice of Reopening” will be issued to notify the provider that the provider’s reopening request has been accepted

Contractors reopening policy and procedures

PARD’s goal is to resolve all cost report reopenings in a timely manner. Every attempt will be made to complete any open or pending reopening(s) as a part of the current year cost report settlement process. Per CMS instructions, situations should not occur where the settlement of reopened cost reports are intentionally delayed. Therefore, all reopened cost reports should be settled within 180 days of receipt of final or remaining information/data necessary to resolve the issue(s).

Denial of reopenings

The responsible audit manager will:
1. Deny the request if it submitted beyond the three-year time limit;
2. Determine if the Medicare reimbursement is greater than the minimum threshold of $5000 for all issues;
3. Review the provider’s documentation to determine if the request lacks sufficient documentation, or is otherwise insufficient and
4. If any of the above three items exists, mail a rejection letter to the provider.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.