Upcoming CMS Medicaid Audits: Strategies for Minimizing Your Chances of Adverse Findings

Foley Partners Daniel Reinberg and Judith Waltz are speaking on a June 19, 2008 audio conference for AIS Health titled “Upcoming CMS Medicaid Audits: Strategies for Minimizing Your Chances of Adverse Findings.”

If you are a provider of Medicaid services and haven’t already received an audit notice from CMS’s newly created Medicaid Integrity Program (MIP), you will soon. Every Medicaid provider is now in CMS’s audit plans, and you need to be fully prepared, soon, for this onslaught of new enforcement activity. With the enactment of the Deficit Reduction Act of 2005, which created and funded the CMS Medicaid Integrity Program (MIP) and separately funded the OIG Medicaid oversight efforts, providers that are usually focused on Medicare now need to make Medicaid a much higher priority … or face consequences that are potentially very time-consuming and very costly. Find out what providers need to do to prepare themselves for these imminent audits.

CMS’s Medicaid Integrity Program is now charging full steam ahead with Medicaid integrity audits, with the agency recently selecting two MIP contractors to conduct audits of Medicaid providers. These audits will review the actions of providers furnishing items or services paid for by Medicaid to determine whether fraud, waste and abuse has occurred, whether the actions of entities resulted in overpayments, and, if so, the magnitude of the overpayments.

Providers that are customarily more focused on Medicare audits are well-advised to shift their attention to Medicaid audits now heading their way. While some of the challenges are the same, Medicaid offers different areas of concern, different risks, and different steps you must take. Most hospital coders haven’t been trained in Medicaid. These providers of services to Medicaid beneficiaries need to take a good, hard look at their billing and coding operations and identify specific risks. Areas such as one-day hospital stays and drugs prone to conversion errors are likely to be the focal points of upcoming audits, and must be incorporated into a provider’s self-auditing procedures. What are the chief Medicaid compliance challenges ahead that may present your greatest risks?

Join us on June 19 to hear attorneys Judith Waltz and Daniel Reinberg provide strategies for identifying specific Medicaid risks and incorporating these risks into audit procedures. You’ll learn what practical steps you can take to prepare for the inevitable CMS MIP audits ahead and the aggressive Medicaid enforcement that is on the way. Topics to be covered include:

• Specific steps you should take today to prepare for MIP audits
• Strategies for identifying and prioritizing your greatest Medicaid risks
• How to incorporate specific risks into your internal monitoring processes
• How to incorporate data mining into your Medicaid compliance
• How to build sound operational policies in areas such as billing and coding that are likely to be the focus of CMS’s Medicaid audits
• Enforcement risks arising from Medicaid audits
• Other audit and enforcement threats, such as the Payment Error Rate Measurement program and Office of Inspector General audits

For more information, please visits AIS Health’s Web site.