Is Your Department Ready for a Medicaid Audit?

Many of PCG’s ambulance clients across the country are familiar with state Medicaid agency desk reviews. These pre-payment reviews help identify reporting errors that could result in overpayment of supplemental Medicaid revenues to providers. Recently, supplemental payment programs in several states have implemented more in-depth audits, generally post-payment, that require submission of even more supporting documentation. Many providers can attest to the challenges of navigating these often-plodding Medicare audits. Audits, however, don’t have to be stressful!

With the right planning and preparation, your agency can breeze through even the toughest audits. Here are some tips for success.

  • DO prepare. Develop working files and document key decisions. A strong audit trail is one that anyone, not just the preparer, can follow.
  • DO organize documentation to have the right information readily accessible. Understand that you will likely have competing priorities and may have limited time to respond to an audit.
  • DO know the common audit triggers. Be prepared to respond to those questions first.
  • DO assemble the right team to help with the audit. Keep in mind that this group may include internal (e.g., accounting, finance, legal) and external (e.g., contractors) partners.
  • DON’T guess. If you don’t understand what auditors are requesting, then ask questions and get clarification, if necessary. The scope of the audit may increase if you misunderstand the audit request and provide the wrong data.
  • DON’T be deceitful. Misrepresenting your data and/or procedures is never worth the risk.
  • DON’T wait until the eleventh hour to start preparing. Do it now!

To learn more about PCG and how we can support your department, visit our website here.

Posted by Rachel Ray

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