Final Determination

30.1 - Final Determination (Rev. 29, 01-02-04) For purposes of this chapter: A final determination is deemed to occur upon final settlement of a cost report when both an NPR and a written demand for payment of an overpayment or a written determination of an underpayment is transmitted to a provider based upon: • An audited final settlement; • Final settlement without audit; or • Reopening for any reason. In cases in which an NPR is not used as a notice of determination, one of the following determinations is issued: • A written determination that an overpayment exists and a written determination for payment; • A written determination of an underpayment; • An Administrative Law Judge (ALJ) or hearing officer’s decision that reduces the amount of an overpayment below the amount that CMS has already collected. A final determination is deemed to have occurred only when the amount of the overpayment/underpayment has been calculated. This may be at the decision time and it may be at a later time if recalculations are necessary. • A written determination that an As Filed Cost Report has been received without payment; • A written determination that an accelerated payment or advanced payment has occurred and has now been deemed an overpayment. A final determination is deemed to occur upon the due date of a timely filed cost report which indicates an overpayment is due CMS and is not accompanied by payment in full. A final determination is deemed to occur with respect to a cost report that is not filed on time, from the date due until such time as the cost report is filed.