CMS Pub. 100-16, ch. mc86c18a, § 20.2.1

Final settlement with an HCPP is based on information in the cost report, subject to the

Medicare program's standard audit and retroactive adjustment procedures. In addition,

CMS retains the right to conduct an independent audit of the information contained in the

final cost report.

Final settlement for HCPPs will equal the total reimbursable costs incurred by or on

behalf of the HCPP throughout the contract period for furnishing covered care to the

HCPP's Medicare enrollees (less applicable deductible and coinsurance). Once the final

determination of reasonable costs is made, CMS will promptly notify the HCPP by

sending a Notice of Program Reimbursement (NPR). This notice will:

• Explain CMS' determination regarding total reimbursement, including an

explanation of the computation of overpayments or underpayments;

• Relate this determination to the HCPP's claimed total reimbursement;

• Explain differences between the HCPP's and CMS' determination; and

• Inform the HCPP of its right to have the determination reviewed at a hearing.