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Medicare Administrative Contractor Cost Report Oversight—Contract Review

Announced on  | Last Modified on  | Project Number: A-04-22-06264
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

In accordance with their CMS contracts, Medicare administrative contractors (MACs) are responsible for accepting, auditing, and settling provider Medicare cost reports. The MAC performs desk reviews of all cost reports and audits as warranted prior to settlement of the cost report to determine adequacy, completeness, and accuracy and reasonableness of the data in the cost report. We will review the MACs cost report oversight by verifying the number of desk reviews and the number of audits performed in accordance with the CMS contract and identify non-compliance issues. Following this review, we will conduct additional reviews that will include MAC audit findings and recommendations to determine whether the provider implemented the recommendations and took corrective action. Finally, we will examine CMS's oversight of the MAC cost report desk reviews/audits. Our audit's objective is to determine whether the individual MACs met requirements stated in the MAC contracts.

TIMELINE

REPORT PUBLISHED

Medicare Administrative Contractors Did Not Consistently Meet Medicare Cost Report Oversight Requirements (A-04-22-06264)

25-A-04-056.01 to CMS - Closed Implemented
Closed on 08/07/2025
We recommend that the Centers for Medicare & Medicaid Services provide MACs with a thorough explanation of the QASP results.

25-A-04-056.02 to CMS - Open Unimplemented
Update expected on 02/07/2026
We recommend that the Centers for Medicare & Medicaid Services update the audit program to incorporate revised change requests and TDLs so MACs can obtain a better understanding of CMS expectations and be evaluated on current requirements.

25-A-04-056.03 to CMS - Closed Implemented
Closed on 08/07/2025
We recommend that the Centers for Medicare & Medicaid Services offer MACs additional training and guidance, based on the results of their QASP, and include best practices used by MACs.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship
Target Groups
-
Financial Groups
-