If your office has had the pleasure of being invited to be a part of a Medicaid audit, then you may be somewhat happy to hear about the slight improvement to their audit process.
Medicaid's program integrity has put in place a new process to improve the way Audit Medicaid Integrity Contractors or Audit MICs conduct Medicaid provider audits. As of October 1, 2010, changes occurred in two areas.
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The Look Back Period
Prior to its implementation, there was no time limit in which an Audit MIC could request and review Medicaid claims. The new policy limits the time to five (5) years prior to the start date of the audit. Most providers keep at least 6 years of records on hand due to HIPAA requirements.
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Documentation Requests
Before the change, providers had to submit any documentation requested from an Audit MIC within ten (10) business days from the date of expected delivery of the letter plus an allowance of five (5) business days for delivery.
The revised policy allows the provider thirty (30) business days to submit documentation. Providers will also have an option to request a fifteen (15) day extension from the Audit MIC. If for any reason forty-five (45) days is just not long enough and you absolutely cannot get it submitted within that time frame, CMS approval will be required for any amount of time beyond that.
Sources:
Budetti, Peter. Informational Bulletin. Center for Program Integrity. September 29, 2010 "CMS Center for Program Integrity (CPI) Bulletin"
