US · guidance
CMS Pub. 100-05, ch. 5, § 70.4
Assessment of Hospital Review
The reviewer shall complete the assessment form (§70.5.1, Exhibit 1) for each hospital
reviewed. The reviewer shall include selection criteria for the hospital, findings, and
suggested recommendations, if appropriate. The reviewer shall include any discrepancies
between the hospital's MSP policies and practices, as well as any hospital innovations
that have been/are being devised to determine primary plan resources. The reviewer shall
note any discrepancies between the hospital's MSP policies and those required by law.
The reviewer shall complete the Survey of Bills Reviewed, provided as an attachment to
the assessment form. (See §70.5, Exhibit 2.) The reviewer shall indicate whether any
follow-up action is needed in the appropriate column. If no follow-up action is needed,
the reviewer shall enter "none." If action is needed, the reviewer shall briefly describe
action required and time frame within which follow-up will commence. It is not
necessary to estimate when action will be completed. The A/B MAC (Part A) shall send a
copy of the assessment form, with its attachment, to the MSP Coordinator at the RO
representing their MAC jurisdiction and to the ART system within 30 days of the date the
review is completed.
The A/B MAC (Part A) shall send the hospital a copy of the assessment form as well.
It shall follow-up every 30 days until appropriate corrective action is taken. It shall
report continued problems after three months to the RO MSP Coordinator. The A/B
MAC (Part A) may contact the RO MSP Coordinator representing its jurisdiction after
90 days if the hospital has not implemented any of its action plans. The RO shall
follow-up with the provider as necessary to discuss when the action plans will be
implemented.
History
(Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
15856bf303fde34bb677cc5c4db9d391d480a65b1ae468477da0de66d875ce32
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