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April 5, 2016

CGS Desk Review Process

Generally, cost reports that aren’t going to audit receive a desk review. A desk review is an analysis of the provider’s cost report to determine its adequacy, completeness, and accuracy and 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. If additional documentation is necessary to complete the desk review, the auditor will send the provider representative a documentation request. The due date for information on the initial document request is three weeks from the date of the request.  If the documentation is not received timely the auditor may propose an adjustment due to lack of documentation. Once the desk review is complete the auditor will send a Pending Settlement Letter (PSL) to the cost report contact. The cost report contact must notify the auditor in writing with supporting documentation within two weeks of the date of the letter of any concerns they may have regarding the adjustments. The cost report may be settled at any time once the two weeks noted in the PSL expire.

Common Desk Review concerns:

  • Amended cost reports may be accepted under limited circumstances. Please see instructions related to amended cost reports on the “Filing an Amended Cost Report” Web page.
  • Due to restrictions on sending sensitive data via the internet provider communications has become a challenge. In order to comply with CMS standards A&R staff must utilize SecureZIP for Windows to encrypt files that include PHI or PII. If you do not have SecureZIP, you can download a copy at http://www.securezip.comExternal Website. Alternatively, you can use the free ZIP Reader by PKWARE(R). A copy of ZIP Reader is available at http://www.zipreader.comExternal Website.  If you experience difficulty using SecureZip please work with your local IT department.  
  • New effective April 25, 2016 cost reports and correspondence may be submitted via myCGS – the Jurisdiction 15 Web Portal. Refer to the myCGS Web page for further information.
  • Due to the CMS mandated settlement timelines, there are times when the auditor does not have the ability to provide extensions to the above noted deadlines.  
  • Often we find that the cost report contact and or email address on file at CGS is not correct. Please email the proper cost report contact to J15STAR@BCBSSC.com.
  • CGS doesn’t have the provider’s Bad Debt Collection policy or Organization Chart. Please note these items are necessary and non-responsiveness to the request for these items will lead to lack of documentation adjustments.
  • Settled cost reports are utilized for future tentative settlements and rate setting. Lack of documentation adjustments not resolved prior to settlement of the cost report could lead to cost report overpayments and lower interim rates in future periods.
  • Once a cost report is settled with a lack of documentation adjustment the resolution of the adjustment must be completed via the reopening process. Typically a reopening can take 180 days from the date that all necessary data is received to be processed.

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