Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important information relevant to PPS payments (including DSH and IME). Forms are also available for hospitals reimbursed under the TEFRA, as well as CAHs.

Select the appropriate interim rate documentation form, complete and return to the appropriate Medicare Audit and Reimbursement address for your facility.

• CAH Interim Rate Review Documentation Request Form
• Hospice PIP Documentation Form
• Hospital Interim Rate Documentation Form
• TEFRA Hospital Interim Rate Documentation Form

Please share your thoughts about your experience with our Audit and Reimbursement process. 

Revised 4/11/2024