The instructions alone stretch out for 291 pages. The completed form (CMS-2552-10, if you're playing along at home) prints out into a stack of papers more than an inch thick. And the audit and reimbursement process lasts for years — even if there are no appeals. Welcome to the complex and opaque realm where the federal government pays hospitals for services to patients covered by Medicare. And then hospitals justify the expenditures for which they have been reimbursed. And then third-party auditors review those justifications. It's as exciting as it sounds.