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Provider Audit & Reimbursement FAQ's

Medical Review Audit &
Reimbursement
Medicare
Secondary Payor
Claims Enrollment
  1. Why am I on Withhold?
  2. What is my per diem, Part B %, etc.?
  3. Can you supply me with a claim payment calculation?

Why am I on Withhold?

Look at the remit carefully. You could be on settlement withhold due to the fact that you did not send a check for an interim rate, tentative or final settlement overpayment due to Medicare. You could be on penalty withhold because you did not send a credit balance or a cost report. Claims withhold could be due to the fact that claims were adjusted and there was no money to pay at the time. When claims were paid and there was money to be paid, the system withholds the amount that was previously adjusted before it made the payment.
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What is my per diem, Part B %, etc.?

Your per diem and outpatient payment percentage should be located on your remit.
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Can you supply me with a claim payment calculation?
Yes. Claim payment calculations are available for time periods beginning 10/01/98 and after. Go to the downloadable forms and files section to retrieve.
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