NCTracks Offers Audit Guidelines

The February Medicaid Bulletin offers guidelines on responding to post-payment audit requests from the Division of Medical Assistance (DMA) Office of Compliance and Program Integrity (OCPI), which oversees audits by several agencies. The guidelines clarify that:

  • You do not need to get a signed record release consent from the patient to access their records for an audit. When applying for Medicaid, beneficiaries must sign a release authorizing access to their records by appropriate regulatory agencies.
  • Prompt response is key. If you are notified you need to submit service provision documentation for a Medicaid client, the submission process is extremely time sensitive. Timelines may vary slightly among audit agencies; but, usually the materials are due within 30 days upon the date of the notification letter, not the received by date.
  • If the auditing entity requests additional documentation about the case, the time limit for returning this information is often shorter than the time limit indicated in the initial request. To minimize any delay, all documents related to the claim should be sent with the initial request.
  • Audit notification letters will include a list of specific items from within the specified Medicaid beneficiary’s file to send to the requesting agency.
  • If providers have any doubt regarding the request, they should first contact the listed OCPI representative. Additionally, providers may call the Medicaid Contact Center in RTP. The local number is 919-813-5550, and the long-distance number is 1-888-245-0179. The call center staff will provide general facts and resolution of the information requested. OCPI will make every effort to ensure the provider’s claims are reviewed fairly.
  • If the additionally requested information is not submitted in a timely manner, there is an increased risk of the case being designated as an error. Not only will the State be held responsible for this designation and be required to implement corrective action plans with the providers; but, the provider will potentially be required to pay back all monetary gains that had been reimbursed related to the claim.

Share this Post