Provider audit and reimbursement department (PARD) overview
The primary functions of the PARD are:
- To set the rate that pays the claims for Medicare Part A providers by:
- Reviewing pass-through payments and cost-based interim rates e.g., cost per discharge, cost per day
- Setting prospective payment system (PPS) rates
- Setting periodic interim payments (PIP)
- Reviewing “as filed” cost reports and determining tentative settlements
- Issuing retroactive lump sum adjustments to correct reimbursement
- Updating various payment limitations e.g., rural health clinics / federal qualified health centers (RHCs / FQHCs) limits, Tax Equity and Fiscal Responsibility Act (TEFRA) limits
- Reviewing pass-through payments and cost-based interim rates e.g., cost per discharge, cost per day
- To review / audit and settle providers’ cost reports to provide reasonable assurance that program payments are based on Medicare reimbursement principles.
- To process cost report reopenings, exception requests, and provider cost report appeals.
- Provider appeals may be resolved through either administrative resolution, mediation or by the Provider Reimbursement Review Board (PRRB).
- Provider appeals may be resolved through either administrative resolution, mediation or by the Provider Reimbursement Review Board (PRRB).
- To send to CMS a hospital cost report information system (HCRIS) data extract within 30 days every time a revised report is issued.