Those providers which can have a settlement, have another worksheet on their Medicare cost report that compares interim payments with Medicare reimbursement deserved, and the difference is the settlement, which can be positive or negative. The reimbursement deserved can be based upon costs, such as a Critical Access Hospital or a Rural Health Clinic, or can be based upon a predetermined rate per day/visit/case, generally referred to as PPS – Prospective Payment System rates.  There may also be other elements which can effect a settlement, such as certain pass-throughs of costs for PPS providers, bonus payments, or Medicare bad debt.