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MIC Audit Management
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Healthcare - CMS Medicaid MIC Audits
According to some estimates from CMS, the Medicaid Integrity Program, through the use of MIC audits, is expected to recover more overpaid revenues than the CMS RAC (Recovery Audit Contractor) program for Medicare. Without the proper tools, both providers and MCOs risk losing legitimate revenues through the MIC audits.
The MIC audit process is unique compared to other forms of CMS Audits such as MAC and RAC. The appeals process is managed at the State level and will vary from one state to the next. Also, unlike the Medicare RAC auditors, MIC auditors currently are not bound by limits on the number of claims records they can request in each audit. Because the scope of a MIC audit can be very large, and because of the complexities created by the varying processes from State to State, healthcare providers and managed care organizations will face many new challenges as they work to defend their legitimate revenues from recoupment.
MIC audits are conducted in distinct steps with each managed by a different type of MIC Audit Contractor:
The Review MICs are contracted to review actions of entities that provide Medicaid items or services. They are tasked with evaluating risks to the Medicaid programs, in terms of both financial risks and risks related to quality of care. They are also looking for indications of potential fraud, waste and abuse. Providers will most often be selected for audits based on data analysis by the Review MICs. They also will be referred to the Audit MICs by State agencies. The Division of Fraud Research and Detection (DFRD) will utilize algorithms to help the Review MICs identify Medicaid providers whose billing activities indicate the potential for inaccurate payments. Providers and MCOs will be ranked in terms of risk, to help prioritize MIC audits.
The Audit MICs are contracted to conduct claims audits based on the findings and recommendations of the Review MICs. Audit MICs have the authority to request copies of records, often via a letter. They also have the authority to request interviews with office personnel and have access to facilities. Requested records must be made available to the Audit MICs within the requested timeframes. Generally, providers and MCOs will have at least two weeks before the start of an audit to provide initial documents to the Audit MICs. A partial list of Medicaid Integrity Risks targeted by the MIC Auditors includes:
The Education MICs provide education on payment integrity and quality of care for Medicaid providers and beneficiaries.
Using Compliance 360 to Manage MIC Audits
With Compliance 360, you can manage the entire MIC audit process, from the initial receipt of a request for records, through your State appeals process and adjudication. You can also establish efficient projects for managing proactive self-audits. Using random samples from your claims history, based on the high risk targets of the MIC Auditors, you can quickly assess your financial and legal risks. Armed with this information, you can make informed decisions regarding self-disclosure which often results in favorable treatment such as reduced or eliminated interest and penalties in many states. As an example of the potential favorable treatment for self-disclosure, see the State of New York OMIG Self-Disclosure Guidance.
With the Compliance 360 Claims Auditor for Managing MIC Audits, you can:
Demonstrations of the Compliance 360 Claims Auditor for CMS Medicaid MIC Audits
To request a personal demonstration of the Compliance 360 Claims Auditor, please Contact Us.
Free MIC Audit Training (On-Demand Webinars)
You are also invited to attend our live broadcasts or replay our on-demand recorded training webinars at your convenience. These training webinars have been attended by more than 10,000 participants and have received very positive feedback. Click Here for the full list of live and on-demand training webinars.
To learn how leading healthcare providers are using Compliance 360 to minimize their compliance overhead and risks, and how you can be doing the same, Contact Us today.
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