CMS Pub. 100-06, ch. 1, § 300

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Reserved for Audit Selection Criteria Report

310 - Completing the Audit Selection Criteria Report (ASCR) - (Rev. 1,

08-30-02)

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A. General Instructions

Contractor shall use the report to show all the provider cost reports from high to low, by

Medicare dollars at risk. The ASCR will be extracted from the System Tracking for Audit

and Reimbursement (STAR) and submitted to the CMS BPO Bulletin Board 30 days

after the end of the fiscal year, i.e., October 30.

B. Specific Instructions

The contractor shall complete the columns on the ASCR as follows:

• Provider Number - It shall enter provider's number;

• FYE - It shall enter provider's year end;

• Provider Type - It shall enter appropriate STAR code and appropriate audit

selection criteria (ASC) code(s);

• POA Code - Indicates the designated activity; (P) problem resolution, (O) on-site

review, or (A) audit. A blank indicates desk reviewed only.

• Medicare Dollars Claimed - It shall enter the Medicare dollars claimed from the

audited cost report. Use DRG column for DRG and outlier benefit payments. It

shall use pass-through column for PPS pass-through costs, and Cost-Based

column for all other provider costs claimed;

• Utilization - It shall enter days or visits, as appropriate, for the total patient

population and for the Medicare population. It shall indicate the percent of

Medicare utilization;

• Notice of Amount of Program Reimbursement (NPR) Date - It shall enter date of

NPR; and

• Cost Savings/Dissavings - It shall enter the dollar amount of adjustments to

payment as a result of the NPR.

310.1 - Audit Selection Priorities - (Rev. 1, 08-30-02)

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A. General

The contractor shall use the ASCR to decide which providers to audit. This determines

the audit matrix within the BPRs. It shall base audit decisions upon the results (problems

discovered) of its uniform desk review, professional surveys of filed cost reports, and

prior audit/review findings.

B. Audit Group

The audit group provides for planning audits/initiatives that must be performed either

because a special circumstance requires immediate audit attention, e.g., termination,

merger, fraud or abuse, new providers, or because of special CMS instructions. The audit

group is defined yearly in the CMS Budget Performance Requirements (BPR guidelines).

Generally, existence of a special circumstance dictates that an audit is necessary.

However, the contractor shall use discretion in this area, especially where there is a short

period cost report from a new provider, a relatively small amount of Medicare payment,

low Medicare utilization, or involvement of OIG or GAO, prohibiting an audit.

310.2 - Level of Audit Effort - (Rev. 1, 08-30-02)

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Instructions require that the level of audit effort be determined by the results of the desk

review or professional survey process, taking into account the priority, audit cost-to-audit

savings ratio, and the level of budget resources available. In most situations, audits are

limited. However, compliance with the Government Auditing Standards must be

considered in all provider audits.