Likewise, due to the approximate 3-month lag time, the absence of a record for any given provider in the Provider Specific file that accompanies the PC Pricers DOES NOT necessarily imply that the missing provider is not enrolled in Medicare and/or is not eligible for payment under Medicare. ![]() ![]() A variance between actual Medicare payment and a PC Pricer estimate may exist as there is typically a 3-month lag in quarterly updates to provider data. The final payment may not be precise to how payments are determined in the Medicare claims processing system due to the fact that some data is factored in the PC Pricer payment amount that is paid by Medicare via provider cost reports. The PC Pricer is a tool used to estimate Medicare PPS payments.
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