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Last Modified: 9/30/2022 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 to CMS a hospital cost report information system (HCRIS) data extract within 30 days every time a revised report is issued.
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.