Common use of Interim Reconciliation Clause in Contracts

Interim Reconciliation. Each FQHC-LA's uncompensated care costs must be recomputed based on the actual as-filed cost report for the actual service period. The cost report is filed with AHCCCS covering the federal fiscal year (ending September 30) by April of the following year. SNCP uncompensated care payments made to the FQHC-LA for a DY cannot exceed the recomputed uncompensated care cost limit. If, at the end of the interim reconciliation process, it is determined that expenditures claimed exceeded the individual clinic's uncompensated care cost limit, the overpayment will be recouped from the clinic, and the federal share will be properly credited to the federal government. The interim reconciliation follows the same computation as outlined above in the Interim Computation of Uncompensated Care Costs steps, except that: - The cost per visit is computed based on allowable FQHC-LA cost and total visits pertaining to the actual service period cost report. - Both Medicaid visits and uninsured visits furnished during the service period are applied to the actual cost per visit to determine the clinic's Medicaid and uninsured costs. Medicaid and uninsured visits must be derived from auditable sources, including the State's PMMIS, managed care encounter data, and provider patient accounting records. - Both Medicaid and uninsured revenues, applicable to actual service period and derived from auditable sources, are offset against Medicaid and uninsured costs to arrive at the clinic's uncompensated care costs. - No trending factor will be applied. The uncompensated care costs must again be adjusted to remove costs related to non-emergency services furnished to unqualified aliens. An FQHC-LA's uncompensated care cost limit is determined for the twelve month period in each DY, except for DY 3 in which the uncompensated care cost limit is computed for the three month period ending December 31, 2013. Where a clinic's cost reporting period does not coincide with the DY (or partial DY in DY3), the uncompensated care costs computed for a cost reporting period can be allocated to the DY (or partial DY) based on the number of cost reporting months that overlap with the DY (or partial DY). The interim reconciliation described above will be performed and completed within six months after the filing of the FQHC-LA cost report(s).

Interim Reconciliation. Each FQHC-LAhospital's uncompensated care costs must be recomputed based on the actual hospital's as-filed cost report for the actual service period. The cost report is filed with AHCCCS covering the federal fiscal year (ending September 30) by April Medicare contractor five months after the close of the following yearcost reporting period. SNCP uncompensated care payments made to the FQHC-LA hospital for a DY cannot exceed the recomputed uncompensated care cost limit. If, at the end of the interim reconciliation process, it is determined that expenditures claimed exceeded the individual clinichospital's uncompensated care cost limit, the overpayment will be recouped from the clinichospital, and the federal share will be properly credited to the federal government. The interim reconciliation follows the same computation as outlined above in the Interim Computation of Uncompensated Care Costs steps, except that: - The cost that the per visit is computed based on allowable FQHC-LA cost diems and total visits pertaining RCCs, Medicaid and uninsured days and charges, and payment offset amounts used will pertain to the actual service period (rather than the prior period). Per diems and RCCs will be derived from the as- filed cost report. - Both Medicaid visits ; and uninsured visits furnished during the service period are applied to the actual cost per visit to determine the clinic's Medicaid and uninsured costs. Medicaid days, charges and uninsured visits must payments will be derived from the latest available auditable sources, including data for the State's PMMIS, managed care encounter data, and provider patient accounting recordsservice period. - Both Medicaid and uninsured revenues, applicable to actual service period and derived from auditable sources, are offset against Medicaid and uninsured costs to arrive at the clinic's uncompensated care costs. - No trending factor will be applied. The uncompensated care costs must again be adjusted to remove costs related to non-emergency services furnished to unqualified aliens. An FQHCThe state must ensure that there is no duplication of payments for the same hospital uncompensated care costs under the SNCP and under DSH; SNCP payments must be accounted for in the hospital's OBRA 93 hospital-LA's specific limit. A hospital’s uncompensated care cost limit is determined for the twelve month period in each DY, except for all other hospitals in DY 3 in which the uncompensated care cost limit is computed for the three month period ending December 31, 2013. Where a clinichospital's cost reporting period does not coincide with the DY (or partial DY in DY3), the uncompensated care costs computed for a cost reporting period can be allocated to the DY (or partial DY) based on the number of cost reporting months that overlap with the DY (or partial DY). This is consistent with the methodology for the computation of the OBRA 93 hospital-specific limit for a given DSH State plan rate year. The interim reconciliation described above will be performed and completed within six months after the filing of the FQHC-LA hospital Medicare cost report(s).

Interim Reconciliation. Each FQHC-LAhospital's uncompensated care costs must be recomputed based on the actual hospital's as-filed cost report for the actual service period. The cost report is filed with AHCCCS covering the federal fiscal year (ending September 30) by April Medicare contractor five months after the close of the following yearcost reporting period. SNCP uncompensated care payments made to the FQHC-LA hospital for a DY cannot exceed the recomputed uncompensated care cost limit. If, at the end of the interim reconciliation process, it is determined that expenditures claimed exceeded the individual clinichospital's uncompensated care cost limit, the overpayment will be recouped from the clinichospital, and the federal share will be properly credited to the federal government. The interim reconciliation follows the same computation as outlined above in the Interim Computation of Uncompensated Care Costs steps, except that: - The cost that the per visit is computed based on allowable FQHC-LA cost diems and total visits pertaining RCCs, Medicaid and uninsured days and charges, and payment offset amounts used will pertain to the actual service period (rather than the prior period). Per diems and RCCs will be derived from the as- filed cost report. - Both Medicaid visits ; and uninsured visits furnished during the service period are applied to the actual cost per visit to determine the clinic's Medicaid and uninsured costs. Medicaid days, charges and uninsured visits must payments will be derived from the latest available auditable sources, including data for the State's PMMIS, managed care encounter data, and provider patient accounting recordsservice period. - Both Medicaid and uninsured revenues, applicable to actual service period and derived from auditable sources, are offset against Medicaid and uninsured costs to arrive at the clinic's uncompensated care costs. - No trending factor will be applied. The uncompensated care costs must again be adjusted to remove costs related to non-emergency services furnished to unqualified aliens. An FQHCThe state must ensure that there is no duplication of payments for the same hospital uncompensated care costs under the SNCP and under DSH; SNCP payments must be accounted for in the hospital's OBRA 93 hospital-LA's specific limit. A hospital’s uncompensated care cost limit is determined for the twelve month period in each DY, except for 1) for PCH in DY 5 in which the uncompensated care cost limit is computed for the three month period ending December 31, 2015 and 2) for all other hospitals in DY 3 in which the uncompensated care cost limit is computed for the three month period ending December 31, 2013. .. Where a clinichospital's cost reporting period does not coincide with the DY (or partial DY in DY3DY3 or DY 5), the uncompensated care costs computed for a cost reporting period can be allocated to the DY (or partial DY) based on the number of cost reporting months that overlap with the DY (or partial DY). This is consistent with the methodology for the computation of the OBRA 93 hospital-specific limit for a given DSH State plan rate year. The interim reconciliation described above will be performed and completed within six months after the filing of the FQHC-LA hospital Medicare cost report(s).

Interim Reconciliation. Each FQHC-LAhospital's or physician practice group's uncompensated care costs must be recomputed based on the actual as-filed cost report for the actual service period. The hospital cost report is filed with AHCCCS covering the federal fiscal year (ending September 30) by April Medicare contractor five months after the close of the following yearcost reporting period. The physician practice group cost report is filed with the state also five months after the close of the cost reporting period. SNCP uncompensated care payments made to the FQHC-LA hospital or the physician practice group for a DY cannot exceed the recomputed uncompensated care cost limit. If, at the end of the interim reconciliation process, it is determined that expenditures claimed exceeded the individual clinichospital's or physician practice group's uncompensated care cost limit, the overpayment will be recouped from the clinicrecouped, and the federal share will be properly credited to the federal government. The interim reconciliation follows the same computation as outlined above in the Interim Computation of Uncompensated Care Costs steps, except that: - The cost per visit is computed based on allowable FQHC-LA cost that the RCCs, Medicaid and total visits pertaining uninsured charges, payment offset amounts and any other relevant statistics such as time study or time study proxy data used will pertain to the actual service period (rather than the prior period). RCCs will be derived from the as-filed cost report. - Both Medicaid visits ; and uninsured visits furnished during the service period are applied to the actual cost per visit to determine the clinic's Medicaid and uninsured costs. Medicaid charges and uninsured visits must payments will be derived from the latest available auditable sources, including data for the State's PMMIS, managed care encounter data, and provider patient accounting recordsservice period. - Both Medicaid and uninsured revenues, applicable to actual service period and derived from auditable sources, are offset against Medicaid and uninsured costs to arrive at the clinic's uncompensated care costs. - No trending factor will be applied. The uncompensated care costs must again be adjusted to remove costs related to non-emergency services furnished to unqualified aliens. An FQHC-LAEven for those particular hospitals who were previously allowed to use hospital departmental charges for interim payment purposes, physician professional charges must be used in the computation of uncompensated cost limit in the Interim Reconciliation here and the Final Reconciliation below. A hospital's or physician practice group's uncompensated care cost limit is determined for the twelve month period in each DY, except for all other providers in DY 3 in which the uncompensated care cost limit is computed for the three month period ending December 31, 2013. Where a clinichospital's or physician practice group's cost reporting period does not coincide with the DY (or partial DY in DY3), the uncompensated care costs computed for a cost reporting period can be allocated to the DY (or partial DY) based on the number of cost reporting months that overlap with the DY (or partial DY). The interim reconciliation described above will be performed and completed within six months after the filing of the FQHC-LA cost report(s).