About the Provider Audit and Reimbursement Department Organization
The Provider Audit and Reimbursement Department (PARD) acts as a Fiscal Intermediary between Providers and CMS; pay providers accurately for Medicare Services; and account for provider payments. The Mission of Provider Audit and Reimbursement is to safe guard the Medicare trust funds and exceed our customer’s expectations.
Cost Report Control (CRC)
The Cost Report Control unit receives, accepts and sometimes rejects, converts the as filed cost report and submits the data to CMS. In addition, the unit receives the revised cost report, reviews subsequent payments and other edits, submits the data to CMS and notifies the provider of the final settlement.
Provider Statistical Reimbursement Report (PS&R)
The main purpose of the PS&R system is to provide summary and detail claims data which can be used by providers and Fiscal Intermediaries to complete key parts of the Medicare cost report, in effect acting as a bridge between claims processing and cost reporting. The Medicare PS&R System is developed and maintained by CMS.
Reimbursement
The Reimbursement unit is responsible for performing tentative settlements of as-filed cost reports, performing interim rate reviews, and calculating cost to charge ratios. This unit calculates global rates based on the Federal Register and CMS change requests, determines if interim settlements are due or payable, notifies providers of interim rate changes and updates the provider specific files used in claims pricing.
Audit
The Provider Audit and Reimbursement Department (PARD) is in charge of completing several different projects to determine accurate Medicare/ Medicaid reimbursement to all hospitals in Florida participating in both programs.
Some of those projects include:
Medicare full / limited desk reviews, Medicare full / in-house audits, Medicaid full / limited desk reviews, Medicare / Medicaid reopening, Wage index desk reviews, DSR – Charity audits, and Provider-based determinations.
Appeals
The purpose of the Medicare Cost Report Appeals Unit is to furnish health care providers with a forum to redress Medicare cost report audit adjustment issues. In addition, the unit receives and determines providers’ qualifications for Routine Cost Limit (RCL), Tax Equity & Fiscal Responsibility Act (TEFRA), Certified Registered Nurse Anesthetist (CRNA), and End Stage Renal Dialysis (ESRD) exception and exemption requests.
