I have a new teaching hospital - why don't I see an IME payment on my PS&R?

If this is the first cost report the hospital is filing with IME Reimbursement, the hospital specific IME rate is not set up yet, so there is not yet an IME component to the DRG payment being paid on an interim basis through the PS&R.

Once the first cost report claiming IME reimbursement is filed, the MAC will perform a rate review using that cost report data. At that time, it is likely that an IME DRG rate will be set, and the hospital will start to receive IME payments through the PS&R/claims data.

Note that the hospital will likely receive all IME Reimbursement at Tentative Settlement for the first year - since the hospital did not receive IME interim payments, this underpayment would be reflected on Worksheet S for that first year. The hospital will likely see an underpayment for the 2nd year as well, since it will take a while for the rate review to go into effect using that previously file cost report data.

 

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