957 CMR 9.09 - Audits

(1) General. All information provided by, or required from, any Acute or Non-acute Hospital, Provider Organization, or Parent Organization pursuant to 957 CMR 9.00 shall be subject to audit by CHIA. Each such entity shall make available all books and records relating to its operations for the audit period, as requested by CHIA. Each hospital shall submit all cost information requested by CHIA, including information necessary to document reported costs and monitor the hospital's financial condition.

(2) Processing of Audit Adjustments.

(a) Notification. After audit, CHIA shall notify a hospital, Physician Organization, or Parent Organization of its proposed audit adjustments. The notification shall be in writing and shall contain a complete listing of all proposed adjustments.

(b) Objection Process.

1. A hospital, Physician Organization, or Parent Organization may file a written objection to a proposed audit adjustment within 15 business days of the notice.

2. The written objection must, at a minimum, specify each adjustment to which there is an objection, the reason for each objection, and include all supporting documentation.

3. CHIA may schedule a conference on objections if it determines that a conference would promote resolution of the disputed adjustments.

4. Upon review of the objections, CHIA shall notify the hospital, Physician Organization, or Parent Organization of its determination in writing. If CHIA disagrees with the objections, in whole or in part, CHIA shall provide an explanation of its reasoning. A hospital, Physician Organization or Parent Organization may request an audit adjustment dispute hearing if it does not agree with CHIA's determination.

Notes

957 CMR 9.09

Adopted by Mass Register Issue 1310, eff. 4/8/2016. Amended by Mass Register Issue 1372, eff. 8/24/2018.