Provider Audit and Reimbursement Overview

The primary function of National Government Services, Inc’s Provider Audit and Reimbursement department is to determine a fair and equitable settlement of the provider’s Cost Report.

Reviewing/auditing provider’s Cost Reports to ensure compliance with the principles of Medicare reimbursement and determining final settlement of the Cost Report is a major focus of the department. This function may take one of several forms. The review may take place in the offices of National Government Services, Inc or at the provider’s site. The department processes Cost Report reopenings, exception requests and provider appeals. Provider appeals may be resolved either through administrative resolution, mediation or by the Provider Reimbursement Review Board (PRRB).

Provider Audit and Reimbursement employees also conduct departmental activities including reviewing pass-through payments and rates, prospective payment rates, periodic interim payments and requests for extended repayment plans. “As Filed” Cost Reports are reviewed and tentative settlements determined. The Provider Audit and Reimbursement department issues retroactive lump sum adjustments to correct reimbursement and is responsible for updating various limits. The department is also responsible for disseminating the Provider Statistical and Reimbursement Report (PS&R) on a timely basis and working with providers to resolve issues.