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Hospital characteristics: can an audit be predicted?
1Memphis State University, Fogelman College of Business and Economics, TN 38152.
Hospital & Health Services Administration
|January 1, 1993
Summary
Hospital characteristics like bed size and teaching status can predict the likelihood of a Medicare audit. Understanding these factors helps hospitals prepare for potential cost report reviews by the Health Care Financing Administration (HCFA).
Area of Science:
- Health Services Research
- Healthcare Administration
- Health Economics
Background:
- Medicare-participant hospitals annually submit cost reports for reimbursement.
- Audits by the Health Care Financing Administration (HCFA) can incur significant costs for hospitals.
Purpose of the Study:
- To identify factors influencing the probability of a Medicare cost report audit.
- To develop a predictive model for hospital audit risk.
Main Methods:
- Analysis of 6,270 Medicare cost reports filed in 1986.
- Logistic regression modeling to assess the impact of hospital characteristics on audit probability.
Main Results:
- Hospital bed size, ownership type, teaching status, and function are significant predictors of audit probability.
- The proportion of Medicare inpatient days and geographic location also influence the likelihood of an audit.
- Audit probability can be predicted with reasonable accuracy using these hospital characteristics.
Conclusions:
- Specific hospital attributes are associated with a higher probability of undergoing a Medicare audit.
- This research provides insights for healthcare administrators to anticipate and manage audit risks.
- Findings can inform HCFA's audit selection strategies.