Health Information Management

Expect CMS outreach in preparation for Medicaid audits

HIM-HIPAA Insider, October 13, 2009

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CMS plans to roll out its Medicaid Integrity Program (MIP) nationwide by the end of the year, according to CMS representatives who spoke during CMS’ Medicaid Integrity Program Special Open Door Forum (ODF) call July 15. Approximately 500 audits are already underway in 17 states.
Know the program basics
Medicaid Integrity Contractors (MIC) should meet the following four goals, according to CMS:
  • Review provider actions to determine whether fraud, waste, or abuse may have occurred
  • Audit provider claims
  • Identify overpayments
  • Educate those involved in Medicaid administration, providers, managed care entities, beneficiaries, and others with respect to payment integrity and quality of care
For more information on the Medicaid Integrity Program, or to purchase a copy of this article for $10, visit the HCPro Web site. Subscribers to Briefings on Coding Compliance Strategies have access to this article in the September issue of the newsletter.

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