Audit Process
The purpose of the audit process is to perform an examination of financial transactions, accounts, and reports as they relate to the Medicare cost report in order to test the provider’s compliance with applicable Medicare laws, regulations, manual instructions, and directives. The audit process impacts Medicare providers and home offices that are required to file a cost report or cost statement, CMS, and the Provider Audit department.
An audit plan is developed at the start of the option year. Both in house and on site field audit audits are conducted each year. Audits must meet expectations and time frames established by CMS for different stages of the audit process.
Auditors will contact the provider to notify them of the upcoming audit and to confirm the audit dates. A confirmation letter will be sent to the provider once the audit dates are confirmed. A preliminary request and engagement letter including a listing of items needed at entrance conference will be sent to the provider 4-6 weeks prior to the start of the audit. The in charge auditor should be contacted with any questions on the information being requested.
An entrance conference is held on the first day of the audit, documentation requested in the engagement letter is inventoried and the entrance conference minutes are prepared and signed.
A pre exit conference is held at the end of the review of the documentation received for exceptions that were raised for audit. The pre exit conference is generally held within 28 days of the audit start date but the time may vary based on issues encountered during the review. Adjustments are discussed and outstanding items are reviewed at the pre exit conference. The provider will receive 4 weeks to submit outstanding items and respond to proposed adjustments. The MAC will not generally accept additional documentation after the 4 week deadline and reopenings are not required to be accepted for lack of documentation adjustments. Pre exit conference minutes are prepared and signed.
After receiving additional documentation, the MAC will review and send final adjustments within four weeks and schedule a final exit conference within two weeks of the final adjustment report being sent to the provider.
The final exit conference will be held to discuss final adjustments which include any revisions from the review of additional documentation received by the established deadline. A final exit conference may be waived if the provider does not feel that a final exit conference is necessary. Exit conference minutes are prepared and signed.
The notice of program reimbursement will be issued within 60 days of the final exit conference.
Reviewed: 12.02.22
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