Rate Information
Rate Information or Requests
A provider is paid one of the following methods:
- Per Diem or Prospective Payment System (PPS) (aka Bill-by-Bill)
- Periodic Interim Payments (PIP) - an estimated bi-weekly payment Note: PIP method is no longer available for Home Health Agencies (HHA) effective October 1, 2000).
- Fee Schedule
Under the per diem and PIP types of payment, a provider may also receive a Level Payment (LP) for costs that are not paid Bill-by-Bill. This is also an estimated bi-weekly payment. These LP costs include: Bad Debts, Organ Acquisition Costs, Graduate Medical Education and CRNA (in certain instances). The amount of the bi-weekly payment will initially be reviewed prior to the start of the provider's fiscal year and will be determined from the most recent cost report on file. A second review of the level payment will be performed in conjunction with the tentative settlement of a newly filed cost report.
Professional judgment will be exercised in determining if an adjustment to the bi-weekly payment(s) or per diem rate is warranted. This may include determining if an additional retroactive payment is necessary or recouping previously paid funds.
PIP Method of Reimbursement
Providers that have been approved for the PIP method of reimbursement must file timely and accurate PIP reports. Providers subject to the Prospective Payment System (PPS) must file
semi-annual PIP reports, generally after the first and third quarters. Based on the provider's financial stability, billing practices, and history of overpayments, we may require them to file quarterly PIP reports.
PIP providers must file a HCFA-91 Report (PIP Report) after each quarter or semiannually (first and third quarters) of their fiscal period. The PIP reports are required to be submitted 30 days after the end of the quarter.
Per Diem Method of Reimbursement
Providers that are paid on a per diem can request their rate to be reviewed (whether increase or decrease); however, we ask that it is at minimum on a quarterly basis and actual data is available.
Fee Schedule / Fee For Service Reimbursement
Payments received under the Fee Schedule or Fee For Service is considered a final payment. These payments are not required for cost reporting purposes.
Prospective Payment System (PPS)
The Social Security Amendments of 1983 (Public Law 98-21)
established the PPS for hospital inpatient services provided to Medicare beneficiaries. Under this system, a hospital is paid a fixed amount for each patient discharged in a particular treatment category or Diagnosis Related Group (DRG).
The Centers for Medicare and Medicaid Services (CMS) has a web page that will allow you to calculate a payment for a specific DRG. See PPS PC PRICER on our web-page for a link to this site.
Should you have any questions regarding the information on this page or have any questions that was not covered on this page, please contact the Audit Supervisor assigned to your provider at 1-866-734-9444. Refer to our Contacts page for names and telephone numbers.
Page Last Updated: Wednesday, 31-Dec-2008 10:49:09 CST
