CMS, OIG, and NIH Audits

Hospital systems often work with CMS auditors to check the validity and quality of their healthcare services and financials. Hospital directors can benefit from referring to CMS resources that can help smooth the process of filing a Medicare cost report. Let’s take a look at some of the most useful resources:

• MAC by Region is a review of Medicare Administrative Contractors by State, as well as links to specialty contractors and contractor websites. This is located on the official CMS Website.

• Approved RAC Topics is a review of referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies. These are topics which may be proposed by hospitals for reimbursement, all listed on the official CMS Website.

• The Government Health Administrators are contractors that provide regular guides and guidelines on auditing for cost reports, acting as a customer service for CMS.

• The US Department of Health & Human Services’ Office of Inspector General hosts a comprehensive inventory of its reports and publications pertaining to CMS.

• The US Department of Health & Human Services’ National Institute of Health hosts comprehensive compliance guidelines for its grants & funding.