Finalization of Audit Adjustments

60.11 – Finalization of Audit Adjustments (Rev. 84, Issued: 11-16-05; Effective Date: 12-05-05; Implementation Date: 12-05- 05) Use the time period between the pre-exit conference and exit conference to review any additional documentation submitted by the provider in response to your request at the pre-exit conference or in support of the proposed audit adjustments that the provider did not agree with. CMS encourages continuing dialogue during this period between you and the provider for issues where agreement was not reached at the pre-exit conference. However, it is not necessary to consider any documentation that is received after the timetable provided at the pre-exit conference unless prior arrangements with the provider have been made. While you should not refuse to accept documentation submitted after the established timeframes, you do not need to consider it in the initial NPR issuance. If a reopening is later granted (see §100ff of this chapter) or a timely appeal is made, the late documentation may be considered at that time. At the conclusion of your review of the provider’s documentation, prepare an audit adjustment report (see Exhibit VI in §170 of this chapter) and clearly identify all new or modified adjustments that the provider did not see previously by indicating the date of the change. Send this audit adjustment report to the provider with a request to notify you in writing, within 2 weeks, of any concerns with the new or modified adjustments. Also, inform the provider in writing that the audit adjustments will become final after you make any necessary modification based on those written concerns and documentation supporting them. Therefore, any documentation submitted later (e.g., at the exit conference) will not be considered for the purpose of issuing the Notice of Amount of Program Reimbursement (NPR). Unless you can document extenuating circumstances, you have up to 12 weeks from the pre-exit conference for the finalization of the audit adjustments. This period include the 4 weeks given to the provider to submit additional documentation and the “2 weeks” that you must give the provider to review and comment on any audit adjustments not presented at the time of the pre-exit conference.