Post-Payment Medicaid Audits in Michigan
By: John Paul Hessburg and Kally Goodwin-Ratzloff

Michigan’s Department of Health and Human Services Office of Inspector General recently announced that it will initiate post-payment reviews of Medicaid claims for the purpose of identifying and recovering any overpayments made to providers. AdvanceMed is the Unified Program Integrity Contractor (UPIC) that will perform these audits.

Providers can expect that these audits will involve statistical sampling, extrapolation, and claim-specific auditing methodologies. AdvanceMed will conduct interviews, perform onsite visits and review medical records to confirm that Medicaid payments were for covered services that were properly documented and billed.

Upon completion of a review, AdvanceMed will notify the involved provider of its findings. If the provider agrees with the findings the next step is to correct the relevant claims in the claims processing system. If the provider disagrees with the findings it has the option to appeal. It is important for the provider to pay close attention to any correspondence from AdvanceMed, as the “Final Notice of Recovery Letter” will outline the provider’s rights including the deadline for submitting an appeal.

Your staff’s documentation will be an important factor in these post-payment reviews. Continuing to educate staff on proper documentation practices has always been important, but is now of paramount importance with the uptick in Medicare & Medicaid audits. If you need assistance with educating your staff on best practices for documentation, or with your responses to any audits, please contact a member of our Post-Acute Care practice group.