Government Accounting Services and Medicaid Auditing

The vendor is required to provide government accounting services and Medicaid auditing are done on an annual basis for three years prior to the current state fiscal year.  
- Hospital compliance audits
•    Within 60 days of the end of a compliance audit period, the state shall notify vendor of the exact number of hospitals that qualify for compliance audit in that period.
•    Timeline: vendor shall complete hospital compliance audits every two years in even numbered state fiscal years, audits are due on august 15 of each year
•    Major hospitals are required to reduce or discount total billed charges by at least 30% if the patient meets established criteria.
•    A statistically valid random sample of inpatient bills to ensure uninsured patients were advised of their rights to receive a discount and patients who made reasonable arrangements to pay were given the 30% discount and note any discrepancies.
•    Hospitals with an outpatient pharmacy, access a statistically valid random sample of patient profiles for medicare recipients.
•    The variance between the hospital’s records and the amount reported to the state by the hospital for each hospital where a variance of more than 2% is found.
•    Hospitals are required to provide emergency care and services, regardless of the patient’s financial status, with certain exceptions noted in the statute.
•    Hospitals and related entities are prohibited from entering into certain contractual arrangements with physicians or other medical care providers.
•    Hospital staff a listing of all contracts and agreements between the hospital and physicians or other medical care providers, including both rental contracts and other contractual arrangements in force during any part of the compliance audit period. 
•    Employment contracts that call for the payment of a salary only are excluded.
- Cost report audits
•    Timeline:
o    Upon receipt of the as-filed cost report, vendor shall immediately review for completeness, then initiate audit within 90 days.
o    Vendor shall complete audits and any proposed settlement within seven months from the cost report received date.
o    Audits are to be performed annually and based on the end of the fiscal year of each provider and facility.
•    Cost report audits include the following tasks to be completed by vendor:
o    Develop audit policies and procedures, subject to approval by the state, to be updated by mutual consent as needed.
o    Create and maintain a database of all facility providers who are required per code to file medicare cost reports.
o    Solicit cost reports from providers and facilities.
o    Provide training and assistance, as needed, to providers and facilities in completing cost report forms.
o    Revise cost report forms, as needed, and send out with filing instructions to providers and facilities.
o    Receive cost reports and review for completeness.
o    Notify the provider and facility within 15 days of receiving an incomplete cost report detailing the insufficiency.
o    Perform either a desk review or a more detailed verification, with at least one-third of the cost reports having the more detailed verification performed each year (desk review of cost report unless findings require further on-site audits).
o    Verify costs reported by providers and facilities.
o    Perform audit appeal functions following state protocols.
o    Track the status of each provider and facility’s cost report (i.e., forms sent, report received, appeal status and finalization).
o    Provide the status report to the state monthly.
o    Reconcile the general ledger account numbers to the cost centers.
o    Review all costs to determine any variance from the previous year.
o    Review staffing levels.
o    Send final audited and adjusted cost report with a completed notice of program reimbursement (NPR) to the provider and facility by certified mail, return receipt requested, along with instructions for appealing the adjustment.
o    Send a copy of the final audited and adjusted cost report and NPR to the state.
o    Track that the provider and facility signs off (agrees or wants to appeal) on the adjusted report and NPR within 30 days of receipt of the report and NPR.
o    Complete the final settlement forms for payment or collection and send these forms to the state for approval and processing.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: August 15, 2025