Pennsylvania Hospital Audit Program
Description
How to fill out Hospital Audit Program?
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FAQ
The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).
Audit of Income of HospitalsBills should be verified with the fees/charges structure. Concession and waiver on account of fees and other charges should be verified. Bills should be verified with cash receipt book, counterfoil of receipts and cash book. Verification of arrears of bills should be done.
Recovery Auditors who choose to review a provider using their Adjusted ADR limit must review under a 6-month look-back period, based on the claim paid date.
Civil monetary penalties (CMPs) of up to $1,000,000 as adjusted annually2 may be imposed on reporting entities if they fail to report information in a timely, accurate, or complete manner.
What Triggers a Medicare Audit? A key factor that often triggers an audit is claiming reimbursement for a higher than usual frequency of services over a period of time compared to other health professionals who provide similar services.
Medicare RACs perform audit and recovery activities on a postpayment basis, and claims are reviewable up to three years from the date the claim was filed.
RACs review claims on a post-payment basis and will be able to look back three years from the date the claim was paid.
Feff CMS program audits are intended to measure a sponsoring organizationsMedicare Advantage Organizations (MAOs), Prescription Drug Plans (PDPs), and Medicare-Medicaid Plans (MMPs) compliance with all Medicare Parts C and D program requirements.
Recovery Auditors who choose to review a provider using their 0.5% baseline annual ADR limit may review under a 3-year look-back period, per CMS approval.
After the provider submits the requested universes, auditors will assess the data provided and determine whether any other information is necessary. This phase will last six weeks. Field work by auditors - Auditors will conduct webinar audits and evaluate sample data from the submitted universes.
