Audit

The wage index for all eligible short-term acute IPPS hospitals are reviewed annually. Every three years, data are collected and reviewed on the occupational mix of employees for each short-term, acute care hospital.

Email us at:

Costreport.wageindex@palmettogba.com

Providers eligible for Disproportionate Share Hospital Uncompensated Care Payment (DSH UCP) are subject to an audit of data reported on worksheet S-10 of the Medicare cost report.

Email us at:

JMS10@palmettogba.com

Medicare cost reports are subject to reviews to determine the adequacy, completeness and reasonableness of the data reported. Based on initial review findings, cost reports may be subject to in-house or field audits.

Email us at:

JMCostReport@palmettogba.com

For more information:

How to Submit Documentation for Desks Reviews and Audits

A volume decrease adjustment (VDA) may be requested no later than 180 days after the date of the NPR for that cost report, if the following conditions are met:

• Hospital is classified as a Sole Community Hospital or Medicare Dependent Hospital
• Decease of more than five percent in total inpatient discharges compared to the immediately preceding cost reporting period

Requests must be in writing and supporting documentation must be submitted with the volume decrease adjustment request.

Email us at:

JMAudit.Reopening@palmettogba.com

For more information: 

Volume_Decrease_Adjustment_Information (PDF)

A reopening of a cost report may be requested within three years of the NPR if the following conditions are met:

• Cumulative reimbursement impact exceeds $10,000
• New and material evidence is included or a clear or obvious error was made

Requests must be in writing and supporting documentation must be submitted with the reopening request.

Email us at: JMAudit.Reopening@palmettogba.com

For more information:

Cost Report Reopenings for JM

Providers have the right to appeal cost report review determinations. An appeal of a cost report issue can be requested, within 180 days of the NPR, through the electronic filing system, Office of Hearings Case and Document Management System (OH CDMS) located at https://portal.cms.gov/.

Email us at:

NGScostreportappeal2@anthem.com

For more information:

Cost Report Appeals

Stay Up-to-Date on the Latest Medicare Audit and Reimbursement Information.