Desk Review Exceptions Resolution Process

20.3 – Desk Review Exceptions Resolution Process (Rev. 107, Issued: 09-22-06; Effective: 10-01-06; Implementation: 10-02-06) Where possible, resolve the exceptions or variances during the desk review by utilizing the available information and through inquiry. Document the conclusions reached on these issues in accordance with the standards for documentation required by CMS (see §60.9) and explain in Column 9 of the “Summary of UDR Exceptions” that the issue was resolved during the desk review. Where adjustments are made during the desk review, follow the instructions in §20.2.F of this chapter for completing the “Summary of UDR Exceptions”. If you do not have all the information necessary to make an adjustment but it appears that an adjustment is required, request the information from the provider before making the adjustment. For example, do not prepare an adjustment if the provider claimed bad debts for Medicare deductible and coinsurance sooner than 120 days from the date of the first bill without first obtaining information necessary to establish that the patient is not indigent. When additional documentation requests are made to providers as part of the desk review process, ensure that the requests do not violate the provisions of the Paperwork Reduction Act (PRA) of 1980. Requests for additional documentation in connection with desk reviews are generally not subject to PRA requirements if you adhere to the following procedures: • A specific request for documentation must be made to only one entity, (i.e., the provider whose cost report is under review), and • Questions must be specific to that provider's particular cost report. Be considerate of the amount of information you request. If you do request certain information/documentation necessary to resolve a desk review exception(s), inform the provider to furnish this information/documentation within 3 weeks of the date of your request. If the provider does not furnish the documentation within that time-period, either make an adjustment or consider scoping the issue for audit. If you make adjustments during the desk review exceptions resolution process, send them to the provider and request that the provider notify you in writing, within 2 weeks, of any concerns with these adjustments. Also, inform the provider in writing that these adjustments will become final after you make any necessary modification based on the written concerns and documentation supporting them. NOTE: See §60.13 of this chapter for supervisory review responsibilities pertaining to the desk review process.