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

the initial rule: you can’t count on mics following the standardized rules and safeguards that rein in the racs. As stated by steve lokensgard, particular 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 doesn’t provide national standards governing, not similar to 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 providers to come up in a certain period of time?

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• the appeal procedure: what will it be like?

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according to cms, the standards will be based on state law.

going by a cms open door forum on the program, you should not suppose mics to always follow state requirements. Says odf presenter barbara rufo, director of the medicaid integrity diverging and contracting division, “if you’re in state x and the state medicaid agency specifically looks back three years, then we specifically would look back three years. ” but that’s subject to alter.

the second rule: you should 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. As stated by lokensgard, the review contractors will do selective information mining to find issues indicative of an incomplete and erroneous claim. Then the audit contractors will manner and behavior the audits either onsite or as a desk audit. And as stated by cms, education mics will pick up on worries not covered by the other two mics to educate providers and others on medicaid payment integrity and quality of care.

attorney paula sanders, an associate in an activity or endeavor with post & schell in harrisburg, pa. , says that providers are not going to be audited at random by mics, adding that the review mics are going to have already found something aberrant that suggests to them that the supplier goofed up someplace. The mics will check with state and federal entities like medicaid fraud agitate and control units and the hhs office of inspector popular to ascertain the supplier is not below any scrutiny and investigation before they embark on their edit.

the third rule: when you steep your structure and 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 in-depth and efficient, they have to learn and perceive the intricacies of each medicaid program.