The Audited PS&R was Different Than the One Used to Prep My Cost Report. Did I Do Something Wrong?

Why Didn't My Settlement Change? My PS&R Did!

For any prospective payment system facility, such as SNFs, HHAs, and FQHCs, any PS&R imported/ entered into the cost report should show a settlement of zero (with the exception of vaccine charges/ costs).

It is imperative to enter PS&R information into the cost report upon preparation.  However, when your intermediary (MAC) reviews the cost report, they import a new copy of the PS&R, which essentially updates the census (SNF) or visit counts (HHA and FQHC) with any billing processed from the time the original PS&R was downloaded until the cost report was reviewed by the MAC.

Any PS&R, once imported, will show a $0 settlement on the cost report (other than vaccines), since the amount the intermediary paid corresponds to the amount of days/ visits and other charges billed to them and approved by them.  For example, a SNF may have, as of the date of the PS&R on the cost report,1,157 paid days or days pending reimbursement.  The reimbursement for those 1,157 days was included in the total reimbursement on E-1, which also came from the PS&R.  Similarly, an HHA’s or FQHC’s visits would match their reimbursement amounts, as well.

If the days/ visits changed from the time the cost report was completed, which often happens due to lags in billing, the new PS&R which was imported by the intermediary would show the updated days/ visits on the statistics page.  The corresponding reimbursement amount on the reimbursement page would have increased as well, still resulting in a $0 settlement.  Either way, days/ visits/ charges billed would equal days/ visits/ charges reimbursed.

Disclaimer:  This blog does not contain legal advice. What it does contain are our best
explanations, advice, and suggestions to help facilities and cost report preparers to understand the cost report forms and offer suggestions for their preparation. Progressive Provider Services assumes no legal responsibility for the content of this blog, nor for cost reports prepared based on the content herein.

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