CMS Pub. 100-06, ch. 4, § 30.1

For purposes of this chapter:

A final determination is deemed to occur upon final settlement of a cost report when both an NPR and a

written demand for payment of an overpayment or a written determination of an underpayment is

transmitted to a provider based upon:

• An audited final settlement;

• Final settlement without audit; or

• Reopening for any reason.

In cases in which an NPR is not used as a notice of determination, one of the following determinations is

issued:

• A written determination that an overpayment exists and a written determination for payment;

• A written determination of an underpayment;

• An Administrative Law Judge (ALJ) or hearing officer’s decision that reduces the amount of an

overpayment below the amount that CMS has already collected. A final determination is deemed to

have occurred only when the amount of the overpayment/underpayment has been calculated. This

may be at the decision time and it may be at a later time if recalculations are necessary.

• A written determination that an As Filed Cost Report has been received without payment;

• A written determination that an accelerated payment or advanced payment has occurred and has now

been deemed an overpayment.

A final determination is deemed to occur upon the due date of a timely filed cost report which indicates an

overpayment is due CMS and is not accompanied by payment in full.

A final determination is deemed to occur with respect to a cost report that is not filed on time, from the date

due until such time as the cost report is filed.