It can be a tough task for you, dealing with the Medicaid Integrity Contractors (MICs). Here are three rules from attorneys that will help you understand and deal with the MICs better.
The first rule: You cannot count on MICs following the standardized rules and safeguards that rein in the RACs. According to Steve Lokensgard, special counsel with the Minneapolis office of the law firm of Faegre & Benson LLP, MIC audits are conducted on a state-by-state basis. The MIC program does not provide national standards governing, unlike the RACs.
* How far back the MIC auditors can go?
* What's the number of records the MICs can request from providers to come up in a certain period of time?
* The appeal process: What will it be like?
According to CMS, the standards will be based on state law.
Going by a CMS Open Door Forum on the program, you should not expect MICs to always follow state requirements. Says ODF presenter Barbara Rufo, director of the Medicaid Integrity Contracting Division, "If you are in state X and the state Medicaid agency typically looks back three years, then we typically would look back three years." But that's subject to change.
The second rule: You should know the function of the three MIC contractors, and what an audit portends. In a nutshell, the MICs include three types of contractors: review, audit, and education. According to Lokensgard, the review contractors will do data mining to find issues indicative of an erroneous claim. Then the audit contractors will conduct the audits either onsite or as a desk audit. And according to CMS, education MICs will pick up on concerns not covered by the other two MICs to educate providers and others on Medicaid payment integrity and quality of care.
Attorney Paula Sanders, a partner with Post & Schell in Harrisburg, Pa., says that providers are not going to be audited at random by MICs, adding that the review MICs will have already found something aberrant that suggests to them that the provider goofed up somewhere. The MICs will check with state and federal entities like Medicaid Fraud Control Units and the HHS Office of Inspector General to make sure the provider is not under any investigation before they embark on their edit.
The third rule: When you steep your organization in the state's Medicaid billing and documentation requirements, it can put you on par with the MICs. Sanders says that for MICs to be effective, they have to learn and understand the intricacies of every Medicaid program.
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