Revenue Cycle

Medicaid Integrity Contractors: Coming to a hospital near you

Recovery Auditor Report, July 23, 2009

Nearly 500 Medicaid audits are under way in 17 states, and the program will roll out to the entire country through the end of the year, according CMS representatives who spoke on the Medicaid Integrity Program Special Open Door Forum on July 15.

CMS hopes to identify additional contractors within the next few days.

MICs have been termed “RACs for Medicaid,” but there are certainly differences between the programs. For example, the RAC lookback period is three years, but MICs base the length of time on individual state lookback guidelines. Similarly, the number of days a provider has to produce medical record copies for MICs is dependant on state rules, unlike with RACs, where providers have 45 days regardless of their location. In addition, MICs have no set medical request limits, while RACs max out at 200. Also, CMS will not reimburse providers for the cost of copying records, which is also different from the RAC program.

And unlike RACs, MICs are not paid by contingency fee, but rather through a sort of fee-for-service model. The dollars MICs recover aren’t tied to their compensation, according to CMS, although they will be eligible for bonuses based on how “effective and efficient” they are. Finally, in some cases MICs will do desk audits, and in other instances, auditors will come on-site to do the reviews.

MICs will also attempt to coordinate with RACs so as not to audit the same facilities simultaneously, CMS Medicaid Integrity Program field director Rob Miller said on the call.

Read the rest of the article on the Revenue Cycle Institute blog.

Editor’s note: If you’ve undergone a MIC audit, we want to hear from you.

CMS will post an audio recording and transcript to the Special Open Door Forum Web site for 30 days beginning July 24. To contact CMS regarding the Medicaid Integrity Program or audits, e-mail CMS at Medicaid_integrity_program@cms.hhs.gov.

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