Audit Process
The following page outlines the audit process.
Audit Determination
When a Medicare cost report is accepted by our office, a desk review is performed to determine the level of audit review to be completed. The audit can either be completed as a desk review or field audit. A desk review audit will be completed in our office, typically with interaction with the designated provider representative through telephone and written correspondence. A field audit will be completed at the provider's site.
Desk Review
The desk review is an analysis of the provider's cost report to determine its adequacy, completeness, and accuracy and the reasonableness of the data contained therein. It is a process of reviewing information pertaining to the cost report without detailed verification and is designed to identify problems warranting additional review and, where appropriate, to resolve some of those problems/exceptions. The objective of the desk review is to determine whether the cost report can be settled without a field audit (a desk review audit) or whether a field audit is necessary. If a decision is made to field audit the cost report, a properly completed desk review is essential for planning the audit and establishing the audit objectives.Desk reviews are required for all providers filing a Medicare cost report except Hospice and low/no Medicare utilization providers and are performed using the specific CMS Uniform Desk Review program in effect at the time the desk review is being performed.
Desk Review Audit
If the cost report is selected as a desk review audit, the review is conducted entirely from our office. The auditor will perform an initial review of the cost report to determine whether additional information is needed to complete the audit. If information is needed, the auditor will send a request letter to the provider. The provider will then be required to submit the information to our office within three weeks of the request. Once the information is received, the auditor will complete the audit. After review of the audit has been completed, an adjustment report will be sent to the provider. The provider then has 10 days to respond to the adjustments. Once all of the adjustment issues have been resolved, a Notice of Program Reimbursement will be issued. At this point, the provider will be paid if the amount is due the provider or a First Request will be issued if there is an amount due the Medicare program. These audits will be completed within twelve months of the cost report acceptance date in our office.
Field Audit
If the cost report is selected as a field audit, the review will be conducted from our office, as well as at the provider's site. When the review is selected as a field audit, the provider will be contacted by our staff to select a date for the start of the audit fieldwork. The provider will receive an audit confirmation letter after the date for the audit is established. The auditor will do an initial review of the cost report and determine the extent of review to be completed at the provider's site. An information request letter will be sent to the provider four to six weeks prior to the start of the fieldwork. We request that the provider have all of the requested information ready for the auditors at the start of the audit.
At the beginning of the audit, we will conduct an entrance conference with the provider. During the entrance conference, we will discuss the scope of the review to be conducted, establish a contact person for the audit, and set a tentative time and date for the pre-exit conference. Everyone to be involved in the audit should attend the entrance conference.
During the audit, we may identify additional information needed to complete our review. The auditors will request this information in writing from the provider- designated personnel. It is expected the information requested will be supplied, as soon as possible, while we are still at the provider's site.
At the end of the audit, we will conduct a pre-exit conference to go over the proposed adjustments and recommendations. At this time, we will go through any information requested that has not been received. This information must be received within four weeks or it may not be considered for inclusion in the Notice of Program Reimbursement. Under CMS directive, timeframes have been established for the auditor and the provider representative to discuss and reach resolution of proposed audit adjustments and recommendations. These timeframes will be discussed during the pre-exit conference.
While entitled to a final exit conference, the provider also has the option to waive a final exit conference. Waiving a final exit conference must be done in writing or via e-mail.
A Notice of Program Reimbursement will be issued within 60 days of the final Exit Conference. At this point the provider will receive any monies due them or a First Request will be issued for any amount due the Program.
Page last updated: April 28, 2008
