Last Modified: 8/31/2018 Location: FL, PR, USVI Business: Part A
Provider audit and reimbursement department (PARD) overview
The primary functions of the PARD are:
• To set the rate that pays the claims for Medicare Part A providers by:
• Reviewing pass-through payments and cost-based interim rates e.g., cost per discharge, cost per day
• Setting prospective payment system (PPS) rates
• Setting periodic interim payments (PIP)
• Reviewing “as filed” cost reports and determining tentative settlements
• Issuing retroactive lump sum adjustments to correct reimbursement
• Updating various payment limitations e.g., rural health clinics/ federal qualified health centers (RHCs/FQHCs) limits, Tax Equity and Fiscal Responsibility Act (TEFRA) limits
• To review/audit and settle providers’ cost reports to provide reasonable assurance that program payments are based on Medicare reimbursement principles.
• To process cost report reopenings, exception requests, and provider cost report appeals.
• Provider appeals may be resolved through either administrative resolution, mediation or by the Provider Reimbursement Review Board (PRRB).
• To send the Centers for Medicare & Medicaid Services (CMS) a hospital cost report information system (HCRIS) data extract within 30 days every time a revised report is issued.
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