it can be a tough task for you, transaction with the medicaid integrity contractors (mics). Here are three rules from attorneys that will aid you understand and deal with the mics better.

the firstborn rule: you can’t count on mics following the standardized rules and safeguards that rein in the racs. According to steve lokensgard, special advice with the minneapolis office of the law firm of faegre & benson llp, mic audits are conducted on a state-by-state substance and basis. The mic program does not provide national standards governing, unlike the racs. & #xd;

• how far back the mic auditors can go?

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• what’s the number of records the mics can request from suppliers to come up in a certain period of time?

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• the appeal process: what will it be like?

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according to cms, the standards are going to be grounded on state law.

going by a cms open door forum on the program, you ought to not expect mics to at all times follow state necessaries. Says odf presenter barbara rufo, director of the medicaid integrity diverging and 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 modify.

the second rule: you ought to acknowledge 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 indicatory of an not complete and erroneous assert. Then the audit contractors will manner and conduct the audits either onsite or as a desk audit. And according to cms, education mics will pick up on worries not covered by the other two mics to educate suppliers and others on medicaid payment integrity and quality of care.

attorney paula sanders, a partner with post & schell in harrisburg, pa. , says that suppliers are not going to be audited at random by mics, adding that the review mics are going to have already found something aberrant that proposes to them that the provider goofed up somewhere. The mics will check with state and federal entities like medicaid fraud agitate and control units and the hhs office of inspector frequent to assure the provider is not underneath any scrutiny and investigation before they embark on their edit.

the third rule: when you steep your structure and establishment in the state’s medicaid billing and documentation necessaries, it can put you on par with the mics. Sanders says that for mics to be in-depth and effective, they have to learn and understand the intricacies of every medicaid program.