CMS Pub. 100-06, ch. 8, § 60.1.1

Audit

(Rev. 107, Issued: 09-22-06; Effective: 10-01-06; Implementation: 10-02-06)

The field audit confirmation letter should give a minimum of 4 weeks and a maximum of

6 weeks notice of the contractor’s intent to make an onsite visit for the purpose of

conducting a field audit (see Exhibit II in §170 of this chapter for a sample letter). The

engagement letter should be provider-specific and must include the following:

• A list of the required documents that are to be made available by the provider on

the first day of the audit.

• Date of the entrance conference. (Enclose the entrance conference agenda –

Exhibit III in §170 of this chapter.)

• A request that the provider assign a contact person to be the audit liaison.

• A tentative pre-exit conference date set for the last day of fieldwork. (Enclose the

pre-exit conference format – Exhibit V in §170 of this chapter.)

• Notice that an exit conference will be tentatively scheduled during the pre-exit

conference to occur within 8 weeks (or longer if extenuating circumstances arise)

after all the outstanding documentation is furnished by the provider.

• Notice to the provider that all documentation and records requested prior to and

during the fieldwork time must be given to you in a timely manner and that failure

to produce documentation will result in non-negotiable audit adjustments.

• Notice to the provider that, as a general rule, you will not honor any reopening

requests for the “lack of documentation” adjustments. This policy has no impact

on the normal provider appeal rights with the Provider Reimbursement Review

Board.