Outpatient Cost Settlement
Overview
Fee-for-Service outpatient services provided by Georgia hospitals are reimbursed on an interim payment basis and subject to cost settlement. The Department of Community Health (DCH, Department) compares outpatient charges reported on the hospital’s adjusted Medicare/Medicaid cost report to the hospital specific HS&R reports.
Cost Settlements
If it is determined that a hospital is eligible to receive additional reimbursement, the Department will notify the hospital and process a hospital payment.
If it is determined that the hospital was reimbursed more than cost, the Department will notify the hospital of the overpayment. Hospitals will have 30 days from the date of the notice to repay the funds to the Department. Critical access or rural hospitals will have 90 days from the date of notice to repay the Department.
Financial Hardship Criteria
Hospitals facing financial hardship can request in writing a repayment plan. Repayment plans have limited repayment time periods: hospitals three (3) months and critical access and rural hospitals up to six (6) months.
- Any hospital who has less than 15 days cash or cash equivalents (Determined by comparing this amount: [most recent annual expenses available divided by 365 and multiplied by 15] to current [as of date of request] cash-on-hand or cash-equivalent amounts).
- Any hospital whose Reserves equal zero (cash or bonds or CD's, etc.).
- Any hospital who has lost money in operations two of the last three years or last two years consecutively.