Please view the following articles and pages for information on reimbursement and settlement. You will also find links to downloadable fee schedules in this area.
Fee Schedules
- Fee Schedules For 2009
- Fee Schedules For 2008
- Fee Schedules For 2007
- Fee Schedules For 2006
- Fee Schedules For 2005
Medicare "All or Substantially all "Test for Non-Hospital Site Rotations
CMS requires facilities with IME/GME teaching arrangements to maintain written agreements between hospitals and non-hospital sites stating that the hospital will incur “all or substantially all” of the costs of training in that non-hospital site. The spreadsheet will assist providers in determining the total costs of training the hospital incurred.
To address providers’ concerns over documentation requirements to support the “all or substantially all” requirement, CMS has established an alternative methodology that hospitals may choose to utilize in determining and paying for the teaching physicians costs attributable to non-hospital sites. Hospitals are no longer required to pay 100% of the residents’ salaries and fringe benefits (including travel and lodging where applicable) plus the portion of the teaching physicians’ costs at the non-hospital site. Instead effective for cost reporting periods beginning on or after July 1, 2007, a hospital is required to pay at least 90% of the total costs of the residents’ salaries and fringe benefits (including travel and lodging where applicable) and the portion of the teaching physicians’ salaries attributable to direct GME at the non-hospital site.
This spreadsheet is intended for use in determining the minimum payment that must be made from a hospital to a non-hospital setting to meet the “all or substantially all” requirement in order to claim interns and residents that train in non-hospital sites, pursuant to 42 CFR 413.75(b). The requirement is effective for cost reporting periods beginning on or after July 1, 2007. (Federal Register, May 11, 2007, Pgs 26948-26976).
Intern & Resident Info System
- The purpose of the Interns and Resident Information System (IRIS) program is to capture information about interns and residents in approved programs who work at hospitals that participate in the Medicare program as required by 42 CFR 413.86 (Direct Graduate Medical Education) and 42 CFR 412.105 (Indirect Medical Education). This information is used to determine Medicare payments for both IME and GME. Click for more information.
Provider Based Determinations
Reimbursement Information
Provider Reports
- PS&R Summary Report Distribution - PA Providers Only
Cost Report Vendors
Cost Reporting Forms and Instructions
Articles And Other Information
- Extension Due Date of Filing Hospital Cost Reports Due to the Submission of Occupational Mix Data
- Instructions for Provider Credit Balance Reporting Related Activities
- SNF RUG Rates
Submitting Credit Balance Reports
Highmark Medicare Services
Claims Department
Attn: Ms. Novelia Kourouma
P.O. Box 890386
Camp Hill, PA 17089-0386
Submitting Cost Reports
Highmark Medicare Services
Adam Weber, Director Provider Audit & Reimbursement
120 Fifth Avenue
Suite P5301
Pittsburgh, PA 15222-3099