The IMA Quarterly: Q3 2009 page 4
The Critical Half Dozen (continued from page 3)
- 3rd Party Payer Coordination – Of special importance has been the ability to prove that other payers such as Medicaid Managed Care and Medicare have been billed before Medicaid was billed. As you know, Medicaid will deny payment if they know of other coverage whose billing has not been reflected in your Medicaid claim. You can monitor and demonstrate this when needed with the help of the “Detail of Billing Transaction” display. You can also use the IMA MEVS Eligibility Inquiry proactively to check coverage prior to billing.
- Signed Documents on File – OMIG auditors will be looking for full statements, signed by appropriate persons, when a client is transferred from one level of care to another. If such statements aren’t created within your IMA EMR system, paper documents can be scanned and placed in the Electronic Medical Record to assure easy retrieval. At the least, you should create IMA Ticklers for each of these and then make sure that the appropriate paper copies are present for each.
- Billing within 90 Days of service – Prompt billing is a focus of OMIG auditors. In every section of their work plan they emphasize Medicaid must be billed within 90 days of the date of service. Billing later than 90 days must be accompanied by an appropriate exception code. Your IMA Medicaid billing batch lists all claims being billed later than 90 days after the date of service.
If you’ve received notice of an audit and you have previously addressed the six items listed above, you will have little to worry about. Get ready before the auditors come by pulling your own sample to be ready with explanations for issues the auditors may later identify.
You can use the “Plan Payments” Report under Billing & Financial Reports/Coverage/Revenue to identify clients and claims relevant to the payer and time period of the audit. Select clients from different programs, locations and years to help assure you see issues which are bound to vary with the people and practices in place at a given time. If there are paper files involved, be sure you can quickly retrieve required documentation to satisfy auditors’ requests.
Melissa Janidlo in the OMH Financial Unit, 518-474- 6911, is available to produce documents citing OMH regulations if you have followed OMH regulations which your OMIG auditors say are not consistent with their understanding of the regulations.
If OMIG auditors find errors, they are authorized to take back a percentage of the base rate paid to your agency during the audit period. The COPS/CSP report under Billing & Financial Reports will help you assure the base rate payments quoted by the auditors are accurate.
If you would like to participate in a conference call Webinar to go over these points in detail with us, have your questions answered, and also share audit insights with representatives from other agencies using the IMA system, sign up for this Webinar on September 9 and 16 as scheduled on the last page of this newsletter.
Plan coverage report
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