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If you just found out that your Medicaid claims are going to be audited, you need experienced legal advice for the best possible outcome. As a healthcare professional, it can be worrisome to have an audit, but it’s important that you understand that getting audited is a standard procedure. Don’t take your audit as some sort of accusation. Chances are, you will have no problems. However, working with a Medicaid healthcare audit lawyer is the best thing you can do to be successful.
There is a procedure that you need to go through to deal with an audit. Some of the tasks that you’ll need to carry out to get through the process could be cumbersome and distract you from your everyday job responsibilities. That’s just one more reason why it’s best to leave the job to a specialized legal professional.
Why are Medicaid audits carried out?
The purpose of an audit of Medicaid claims is to make sure that you’ve been charging Medicaid accurately and fairly on behalf of the medical services you’ve offered to your patients. Audits prevent fraud and allow the Medicaid program to avoid unnecessary expenses that inflate its costs. The way to get through an audit with success is to demonstrate that you have never filed a claim to Medicaid that inappropriately charged the program for medical care.
The business of Medicaid audits is sometimes confusing due to the fact that many contractors are responsible for these audits. Some contractors do business a little differently than others. As a healthcare practitioner, you can’t assume that you’ll be fine on an audit because you’ve already successfully handled an audit independently in the past. While a healthcare practitioner doesn’t have the specialties to recognize the habits and practices of a particular contractor, an attorney specialized in Medicaid audits does.
Regardless of the contractor you’re dealing with, you should know that it’s possible that the contractor will be very eager to recover Medicaid funds. Hopefully, you run your own occasional audits at your facility to make sure that you’re always charging Medicaid appropriately and accurately. When audits happen, record keeping becomes more important than ever.
Have you just recently received notification that your Medicaid claims are going to be audited? You should be aware of a few things before you get started to ensure that you come through the audit with no issues:
There are quite a few different organizations out there with which you might be dealing with- One of the most important things you’ll need to discuss with your lawyer is which contractor is responsible for the audit. Also, you’ll need to be aware of whether that contractor is a government contractor or a private payor contractor. Some of the different contractors you could potentially be dealing with are Quality Improvement Organizations, Medicaid Integrity Contractors, and Recovery audit contractors.
One of the most important things you’ll need to send in is a list of all your Medicaid claims- Again, records are very important when you’re audited. The quicker you can come up with a list of your Medicaid claims, the faster you can deal with the audit. You’ll need to put together a list of claims and how much was charged at each of these claims.
Getting to work on the audit right away is important- Don’t delay once you find out about an audit. Deadlines are important, and you could face fees or deeper scrutiny if you stall about responding to your audit. When reviewing documentation, make sure to find all due dates and mark them on your schedule so that you can stay on top of them.
You should discuss your responses to the Medicaid Provider Questionnaire with an attorney- You’ll get a Medicaid Provider Questionnaire with your audit. It’s not a good idea to submit this before you’ve discussed all the information you’re providing on it with your attorney.