Key Notes of CR#1468 (PM A-01-82)

Home Provider Part A Medicare Areas Audit and Reimbursement

CMS Audit and Cost Report Settlement Expectations

Acceptability Process

  • No change in what is required to be filed with the as-submitted cost report (A/S/C/R); however, still imperative all 9 items are included when filing your A/S/C/R, page 2 of CR#1468, or see our Cost Report Core Requirements page.
  • Change:If any of the 7 additional items noted on page 3 of CR#1468 is missing, providers will be given 15 days to submit. If no response, Contractors are instructed to REJECT the cost report. (Be sure to include how you calculated your GME per resident amount). For the 7 additional items, see also our Cost Report Core Requirements page.
  • Reminder - Reinforce:If your facility belongs to a Chain Entity (Home Office), it is imperative that the Home Office (H.O.) Cost Statement is filed timely (typically, 5 months from close of cost reporting year end).
     
  • If H.O. Cost Statement is not filed, all H.O., Contractors are instructed to remove costs at Tentative Settlement and PPS / Interim Rates will be reduced.
     
  • Contractors will need to work together for providers that fall in a chain that belong to more than one Contractor.
  • Change:Tentative Settlements (T/S) are now required to be performed within 60 days from "acceptance" date of the A/S/C/R. Before, it was based on "received" date.
  • PS&R Version 27.0 includes the HHA PPS and OPPS billing information for all Contractors.

Audit Procedure Changes

  • Contractors are required to finalize non-field engagements (desk reviews only) within 12 months from "acceptance" date of A/S/C/R.
  • Contractors are given until FY2005 to be current per CMS expectations and BPR requirements.
  • Field engagements are required to be finalized within 75 days from the date of "final" exit conference.
  • Can be finalized prior to 75 days.
  • Engagement letter should be issued giving provider a minimum of 4 weeks, maximum of 6 weeks notice before first day on-site (field engagement reviews only).
  • Be alert to Contractors requesting information. Don't fall into the "lack of documentation" adjustment. See page 5 of CR#1468.
  • Lack of documentation adjustments have significant consequences to the Provider.
  • Reopening requests and Appeal requests to administratively settle could be rejected.
  • Does not impact normal Provider Appeal rights.
  • Does apply to field and non-field engagement types.
  • Providers will be given 4 weeks from the last day on-site (pre-exit conference) to supply any additional documentation.
  • Be aware, depending on the timing of receiving the additional documentation, it may not be included at final settlement; however, could be considered under the reopening process.
  • "Final" exit conference is deemed when all adjustments have been shared with the provider. No additional information accepted.
  • Contractors are required to finalize the cost report within 75 days from this "final" exit conference date.
  • Can be less than 75 days if no issues and Provider is in agreement.
  • Important to resolve open issues during on-site work, at pre-exit, and within the 4 weeks of the pre-exit conference date.
  • Pre-exit and final exit conferences must be held as follows:
  • Conducted at Provider's location
  • Conducted at Contractor's location
  • Conducted over the telephone
  • Waived by the Provider
  • Documentation procedures are extremely important, even for Contractors, especially with requesting additional information.

This information is provided by WPS, Medicare Audit & Reimbursement area. Any questions regarding this information, please contact an Audit Supervisor at 1-866-734-9444 or refer to our Contacts page.

Page Last Updated: Wednesday, 31-Dec-2008 10:49:04 CST