On Wednesday, August 27, the McBrayer Health Care Group co-hosted Part II of a webinar entitled, “Medicaid: Getting Paid and Keeping It.” Co-hosts included Joe Smith from the Kentucky Primary Care Association and Barry Smith from Primary Care Centers of Eastern Kentucky. The series drew a large crowd of participants all wanting to know the same thing: how to navigate the Medicaid reimbursement and audit process. Part II focused on the following topics:

• Federal Medicaid Audit Authority;

• Overview of the Medicaid Integrity Contractors;

• What to do if you are contacted by a MIC auditor;

• Opportunities to contest a MIC Auditor’s adjustments/denials/identification of overpayment

In addition, panelists discussed the top issues that they encounter in practice, as well as emerging trends and questions. If you missed the webinar series, don’t worry! We have both the slides and the recording available for download. In addition, check out some of the questions that were addressed in the conversation below:

What are some of the ways that a Recovery Audit Contractor (RAC) and Medicaid Integrity Contractor (MIC) differ?

RACs, established in 2012 under the ACA, are paid based on the amount of money in improper payments they identify. MICs, in contrast, are not paid a contingency fee. While MICs conduct postpayment auditing to identify overpayments, RACs are instructed to look for both overpayments and underpayments. In addition, RACs are overseen by the States, while the Centers for Medicare & Medicaid Services operates the MIC program.

My facility was recently audited. The Audit MIC concluded that there was a potential overpayment and prepared a report. Do I get a chance to respond to the report?

The MIC’s draft report will be shared with the State and the provider for comment. It is vital that you, as the provider, respond to the report. The report may be revised based on your input. It is important to note that once the report is final, the State will pursue collection of overpayment, not the Audit MIC.

What is the look-back period for MIC audits?

Audit MICs are now limited to a five year audit look-back period, beginning on the date of issuance of the notification letter to the provider. However, CMS stated that it retains the right to adjust the five year look-back period. There are currently no limits on the number of records that a MIC may request; therefore, if you are subject to an audit, it is important to make sure your staff is prepared to produce a voluminous amount of records in an organized and timely fashion.

What do I need to know about re-enrollment in Medicaid?

The State Medicaid agency must revalidate the enrollment of all providers regardless of provider type at least every 5 years. Based upon this requirement, States must complete the revalidation process of all provider types by March 24, 2016. A failure to re-enroll means that CMS will de-activate payment until a successful re-enrollment process is completed. Be sure to watch the mail for your re-enrollment notice and contact legal counsel should you have any questions about the process.