The primary function of the Medicare Audit and Reimbursement (MAR) Department is to

• determine a fair and equitable settlement of the provider’s cost report
• review/audit the provider’s cost report to ensure compliance with the principles of Medicare reimbursement, and
• determine a final settlement of the cost report.

These functions may take one of several forms; the review may take place in the offices of National Government Services or on site at the provider’s facility.

The Medicare Audit and Reimbursement Department processes cost report reopenings, exception requests, and provider cost report appeals. Provider appeals may be resolved either through administrative resolution, mediation, or by the Provider Reimbursement Review Board (PRRB).

The Medicare Audit and Reimbursement Department facilitates the following:

• Reviewing pass-through payments and rates
• Prospective payment system (PPS) rates
• Periodic Interim Payments (PIP), and
• Requests for extended repayment plans (ERP)
• Reviewing “As Filed” cost reports and determining tentative settlements
• Issuing retroactive lump sum adjustments to correct reimbursement
• Updating various payment limitations (e.g., TEFRA cost per discharge), and
• Disseminating the Provider Statistical & Reimbursement (PS&R) report on a timely basis and working with providers to resolve related issues