Audit and Reimbursement

Medicare Audit and Reimbursement is divided among three distinct areas: reimbursement, audit, and cost reports. The primary functions of the Medicare Audit and Reimbursement unit are:

• Assure final payments to providers are in accordance with M0edicare laws, regulations and instructions
• Verify financial and statistical information contained in the Medicare cost report
• Arrive at a correct program reimbursement. In so doing, preserve the provider's interests and rights but at the same time apply program policies to specific situations to ensure compliance with these policies.

Facilities and Organizations Web Page

Please select Palmetto GBA's Facilities and Organizations page for information about specific provider types. These include Critical Access Hospitals, Inpatient Prospective Payment Systems, Inpatient Rehabilitation Facilities, Long Term Care Hospitals, Federally Qualified Health Centers, Rural Health Clinics, and Skilled Nursing Facilities.

Audit and Reimbursement Contact Information

MCReF — Website: https://mcref.cms.gov. Providers can access this portal and receive important information, including NPR settlement packages, rate review letters, tentative and lump sum payment notifications, etc. 

PS&R summary reports — Effective May 13, 2025, Medicare Part A providers have the ability to download PS&R summary reports needed to prepare their Medicare cost report directly in MCReF for eligible providers and specific fiscal year ends. The PS&R summary reports are available via a one-click download in MCReF and are equivalent to the reports that can be generated in the PS&R system and are suitable for cost report preparation purposes. We encourage providers to sign up for an MCReF account and review the information provided before submitting any questions to the MAC.

eServices
For submission of documents to our audit, reimbursement, or wage index teams. Please ensure you select the proper dropdown, so the information travels to the correct area.

• Email: eServices.Support@palmettogba.com
• eServices Portal 

Provider Contact Center (PCC)

Jurisdiction J (JJ): 877–567–7271
Jurisdiction M (JM): 855–696–0705

• Underpayment, overpayment or withholding questions
• Check/payment receipt inquiries
• EFT requests or applications

 Acceptance — Email: STAR@palmettogba.com

• Acceptance or rtejection of cost reports 
• Contact information updates (name and email only, and only for A&R)
• Consolidation requests
• Cost report extension inquiries
• Provider contact updates (select the  Audit and Reimbursement Contact Form (PDF))

Please do not send address updates. These must be sent through the CMS-855A form to enrollment. Providers can sign up for and access the PS&R system to retrieve summary PS&R requests themselves.
 

Reimbursement

JJ Email: JJIRR@palmettogba.com
JM Email: JMReimbursement@palmettogba.com

• Tentative, lump sum and passthrough inquiries
• Per resident amount inquiries
• Hospital-specific rate calculations
• Provider-based determinations
• Low volume adjustments
• RRC/SCH/MDH status/supporting documentation requests
• Interim rate review inquiries
• RHC productivity exemption requests
• New HITECH payment requests

Audit

JJ Email: JJCostReport@palmettogba.com
JM Email: JMCostReport@palmettogba.com

• Questions regarding the treatment of reimbursable areas reported on the cost report
• Questions regarding desk review/audit adjustments if your assigned auditor cannot be reached
• GME Affiliation Agreements
• Stat basis change requests

Please do not send questions regarding collection of overpayment, withholdings, repayment requests or issuance of checks. These questions would be directed to our finance department. Please call the PCC at 877–567–7271. 

Wage Index

JJ Email: JJWageIndex@palmettogba.com
JM Email: CostReport.WageIndex@palmettogba.com

• Submissions of support for wage index or OMS
• Questions regarding wage index allowability
• Questions regarding OMS allowability

Please do not send questions regarding wage index rates published by Center for Medicare & Medicaid Services (CMS). Audit only reviews but has no bearing on CMS' actual wage index calculation after our reviews are completed. These inquiries would be directed to CMS at WageIndex@cms.hhs.gov.
 

S-10

JJ Email: JJS10@palmettogba.com
JM Email: JMS10@palmettogba.com

Submissions of support for S10 reviews and audits.

Reopenings

JJ Email: JJAudit.Reopening@palmettogba.com
JM Email: JMAudit.Reopening@palmettogba.com

• Questions related to currently open NORs
• Requests for new provider-initiated NORs (all supporting documentation must be submitted with request)
• Volume Decrease Adjustment (VDA) requests

Appeals

JJ Email: JJAudit.Appeal@palmettogba.com
JM Email: NGSCostReportAppeal2@anthem.com *

*NGS is the point of contact for Palmetto JM cost report appeals.

• Questions regarding currently open appeals
• Requests for new appeals (all supporting documentation must be submitted with request)

Mailing Information — Hard Copy Desk Review/Audit Support

Mailing Information — Check

Mailing Information — Hard Copy Reopening Support

Miscellaneous Contacts

Audit mailboxes frequently receive questions that need to be routed to other departments. Please contact the below areas if your question is outside of audit and related to claims, enrollment, and so on.

Enrollment

Email: PartA.Enrollment@palmettogba.com — Questions regarding form 855A, physical address changes, or any other enrollment issues or concerns.
 

Credit Balance

JJ Email: JJCredit.Balance@palmettogba.com 
JM Email: Credit.Balance@palmettogba.com

Credit balance report inquiries. Note: The Medicare Credit Balance Report Tool is available as well for lookup of submitted information.

FOIA (Freedom of Information Act)

Email: FOIA@palmettogba.com — Freedom of Information Act requests. Any documentation request that is not related to a file currently being processed by audit.
 

Payment File Development Contractor (PFDC)

Phone: 855–223–1343 (HITECH payment inquiries).