Recovery auditor hot topics: Audit MICs struggling to identify overpayments
Patient Access Weekly Advisor, April 25, 2012
On March 20, the Office of Inspector General (OIG) issued a report that presents an early assessment of the efforts of Audit Medicaid Integrity Contractors (Audit MICs) to identify overpayments in Medicaid. Contained within the report are drastic figures that convey the fact that Audit MICs are having a difficult time identifying overpayments in their audits.
Only 11% of the study-assigned audits were completed with findings of $6.9 million in overpayments, $6.2 million of which resulted from seven completed collaborative audits involving Audit MICs, Review MICs, states, and CMS, according to the report. This leaves 81% of audits that the MICs were unable to or unlikely to identify any underpayments or overpayments. The OIG suggests that problems with the data used and analysis conducted by Review MICs and CMS to identify audit targets led to this performance. Another possible reason for this lack of success in finding overpayments is the lack of an overarching governing body over the Medicaid auditing landscape, suggests William Malm, ND, RN, CMAS, senior data projects manager at Craneware, Inc., based in Edinburgh, Scotland with a US office in Atlanta.
“States are having difficulty auditing on the Medicaid side due to the diversity and complexity of the regulations, and the lack of billing specifics in the individual state guidelines,” he says. “These business practices have not been well documented and there is no defensible source authority to proclaim that something is an overpayment or an underpayment.”
- Study: Almost half of nurses are thinking about leaving the profession
- Fracture coding in ICD-10-CM requires greater specificity
- What does case-mix index mean to you?
- Complications from immobility by body system
- Differentiate between types of wound debridement
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- OB services: Coding inside and outside of the package
- Don’t forget the three checks in medication administration
- What is the difference between an IPA and a medical group?
- Note similarities and differences between HCPCS, CPT® codes
- Bill and charge for supplies correctly to reduce risk and minimize lost revenue
- Seven tips for slashing ED wait times with limited resources
- QA:Coding multiple initial infusions
- Q&A: Query for "Type 2 injury"
- Q&A: Coding using suspected, probable diagnoses
- Q&A: Coding for transplant complications
- Note from the Instructor: Review of hospital inpatient mental health services payable under the inpatient psychiatric facility prospective payment system (IPF PPS)
- Increase patient satisfaction by improving your discharge process
- HIPAA Q&A: Maintenance of medical records after physician death
- Don't underestimate the importance of good documentation