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Facing an Alaska Medicaid provider self-audit?

Did you know?

Effective June 7, 2018, the Alaska Department of Health and Social Services requires all Medicaid providers to conduct a self-audit once every two years. As part of the audit, providers are required to repay all identified overpayments and sign an attestation form to verify accuracy of their audit.

The first self-audit report of 2018 claims is due by no later than June 7, 2020. However, to allow for timely filing of claims, providers may not begin the audit until Jan. 1, 2020.

Are there different reporting thresholds based on Medicaid volume?

Yes:

  • Providers reimbursed more than $30,000 annually, as determined by the provider’s IRS Form 1099, must complete and submit a self-audit report to the department.
  • Providers reimbursed less than $30,000 but more than $10,000 annually must complete a self-audit but are not required to submit a self-audit report to the department. Providers must have the report available for review by the department upon request.
  • Providers reimbursed less than $10,000 annually are required to complete only the attestation.

The attestation form may be downloaded here: https://dhss.alaska.gov/Commissioner/Documents/medicaid/PV-Self-Audit-Attestation.pdf

Do providers have to conduct their audits in-house?

No, Alaska Medicaid providers may contract with third-party auditors, such as Vachette, to complete this process on their behalf.

How many claims must be audited?

The sample size of claims is determined by a statistically valid random sample, using RAT-STATS, a government developed software, or other statistical software. RAT-STATS may be downloaded here: https://oig.hhs.gov/compliance/rat-stats/index.asp.

Audits span one calendar year of paid claims. Feel free to contact us directly if you’re unfamiliar with the program and need guidance utilizing it to determine your sample size.

What is the process to follow when an overpayment is identified?

Any overpayments discovered through the audit process must be reported within 10 days and a repayment agreement must be established within 30 days after the date when the overpayment was identified.

Those overpayments should be sent to:

DHSS/Medicaid Program Integrity Attn: Provider Self-Audits 4601 Business Park Blvd., Bldg. K Anchorage, AK 99503-716

What must be included in the audit report?

The audit report should identify the method used to sample the claims, the sampled claims Medicaid assigned transaction control number (TCN), the outcome of the individual claim audit (i.e. correct claim, incomplete/missing documentation, not medically necessary, billed as a consultation rather than an office visit, up-coded, unbundled), the identified amount of overpayment back to the department, and a corrective action plan.  

What are the penalties for failing to comply?

Those who fail to audit, identifying and return Medicaid overpayments could face a host of penalties, including being forced to pay interest on any overpayments that were not returned in compliance with the program or face sanctions or other administrative and civil actions.

In short, it’s in your best interest to comply.

Interested in learning more about coding audits or improving your overall revenue cycle management? Contact us today for a free consultation.

 

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