Interim Rate Instructions for New Providers
Rural Health Clinics:
Newly Medicare certified Rural Health Clinic’s initial rate is set at $50. If a provider believes that the initial rate is not representative of their cost per visit, they may submit a working trial balance, along with visit data covering the same period for established providers or budgeted cost and visit data for new providers.
Hospitals and Skilled Nursing Facilities (SNF):
Initial pass thru payments for bad debts will be set at zero. Once established, a hospital or SNF may have Medicare deductible and coinsurance bad debts to write off. These bad debts are reimbursed by Medicare at a rate of 65%. If the annualized reimbursed bad debt amount exceeds $15,000, the provider could qualify to receive biweekly pass thru payments. In order to receive these payments prior to the submission of its first Medicare cost report, the provider can submit a copy of the actual listing of bad debts as documentation to support the rate adjustment.
Where to Submit the Rate Request:
Via email to: J15.reimbursement@cgsadmin.com
Or by postage service or courier to:
CGS
J15 Part A Audit & Reimbursement
AG-720
26 Century Blvd STE ST610
Nashville, TN 37214-3685
Reviewed: 12.02.22