About Audit & Reimbursement
The Medicare Audit & Reimbursement (A&R) area determines proper reimbursement to healthcare providers under the Medicare Program, refunds underpayments or recovers overpayments as appropriate and ensures only qualified applicants are enrolled into the Medicare Program.
Primary Functions performed by the A&R Home Office and Field Offices
NOTE: * means both Home and Field Office duties
- Set up providers on the payment system and perform interim rate reviews
- Request and process provider cost reports
- Conduct limited or full desk reviews for all provider types *
- Conduct desk reviews of wage index data for hospitals
- Perform on-site field work *
- Issue tentative, final and revised settlements of provider cost reports
- Review and process provider enrollment applications
- Determine underpayments and overpayments
- Collect and/or withhold overpayments and pay underpayments
- Process cost report reopenings *
- Inform providers of changes in Medicare Program (i.e., Newsletters)
- Testing and furnishing of Provider Statistical & Reimbursement (PS&R)
- Answer provider questions regarding rates, reimbursement, audit* and enrollment issues
- Process exception requests to cost limits Assist CMS when necessary *
Functional Departments within the A & R area
- Audit (Home and Field Offices)
- Reimbursement
- Enrollment
- A&R Technical Support
- Cost Report Appeals
- Cost Report Reopenings
To learn more about Medicare Audit & Reimbursement, be sure to visit all of our sections. We will continue to add more information to our Audit & Reimbursement Website.
Our goal is to provide information that is useful to our customers, so we do want to hear from you!
Page Last Updated: Monday, 09-Jun-2008 13:35:07 CDT
