Section 1200-13-09-.15 - AUDIT(1) All hospital cost reports are subject to audit at anytime by the Comptroller of the Treasury and the Department or their designated representative. Cost report data must be based on and traceable to the provider's financial statistical records and must be adequate, accurate, and in sufficient detail to support payment made for services rendered to beneficiaries. Retroactive adjustments to the prospective rate may be made for audit exceptions.(2) Hospitals will be subject to medical audits at any time. Medical audits include, but are not limited to, "medical necessity" or "length of stay". Medical audit exceptions may result in a direct recoupment rather than a rate change.(3) The Department will provide for all costs of auditing which may be required.Tenn. Comp. R. & Regs. 1200-13-09-.15
Original rule filed June 2, 1988; effective July 17, 1988. Amendment renumbering 1200-13-.10 through 1200-13-.14 to read 1200-13-.11 through 1200-13-.15 filed January 29, 1990; effective March 15, 1990.Authority: T.C.A. §§ 71-5-105, 71-5-109 and 4-5-202.