Interim Settlement Procedures for Medicare Cost-Based HMO/

20.1.2 - Interim Settlement Procedures for Medicare Cost-Based HMO/ CMPs (Rev. 4, 10-01-01) Within 30 days of receipt of the HMO/CMP's final interim cost report and enrollment data or, in the case in which the HMO/CMP is not submitting quarterly reports, within 30 days of receipt of the interim cost report, CMS will attempt to make a determination of the HMO/CMP's estimated reimbursable costs. Obvious errors and inconsistencies will cause delays in CMS’s determination. This interim determination will be made on the basis of the interim cost report for the HMO/CMP referred to in sections 20 and 20.1. For this purpose, costs are accepted as reported except for obvious errors or inconsistencies, subject to later audit or review. An interim settlement payment will be made amounting to the total difference between the amount found payable in the interim settlement determination, and the total capitation payments made to the HMO/CMP throughout the contract period. If the HMO/CMP has been underpaid, CMS will pay the difference within 30 days of the determination. If the HMO/CMP has been overpaid, a refund is due CMS within 30 days of the determination or the due date of the report. The HMO/CMP may negotiate a repayment schedule with CMS if it is unable to pay the required amount by the 30-day deadline.