| It can be a tough task for you, dealing with the | | | | the three MIC contractors, and what an audit |
| Medicaid Integrity Contractors (MICs). Here are | | | | portends. In a nutshell, the MICs include three |
| three rules from attorneys that will help you | | | | types of contractors: review, audit, and education. |
| understand and deal with the MICs better. | | | | According to Lokensgard, the review contractors |
| The first rule: You cannot count on MICs following | | | | will do data mining to find issues indicative of an |
| the standardized rules and safeguards that rein in | | | | erroneous claim. Then the audit contractors will |
| the RACs. According to Steve Lokensgard, special | | | | conduct the audits either onsite or as a desk |
| counsel with the Minneapolis office of the law firm | | | | audit. And according to CMS, education MICs will |
| of Faegre & Benson LLP, MIC audits are | | | | pick up on concerns not covered by the other |
| conducted on a state-by-state basis. The MIC | | | | two MICs to educate providers and others on |
| program does not provide national standards | | | | Medicaid payment integrity and quality of care. |
| governing, unlike the RACs. | | | | Attorney Paula Sanders, a partner with Post |
| - How far back the MIC auditors can go? | | | | & Schell in Harrisburg, Pa., says that |
| - What's the number of records the MICs can | | | | providers are not going to be audited at random |
| request from providers to come up in a certain | | | | by MICs, adding that the review MICs will have |
| period of time? | | | | already found something aberrant that suggests |
| - The appeal process: What will it be like? | | | | to them that the provider goofed up somewhere. |
| According to CMS, the standards will be based on | | | | The MICs will check with state and federal entities |
| state law. | | | | like Medicaid Fraud Control Units and the HHS |
| Going by a CMS Open Door Forum on the | | | | Office of Inspector General to make sure the |
| program, you should not expect MICs to always | | | | provider is not under any investigation before |
| follow state requirements. Says ODF presenter | | | | they embark on their edit. |
| Barbara Rufo, director of the Medicaid Integrity | | | | The third rule: When you steep your organization |
| Contracting Division, "If you are in state X and the | | | | in the state's Medicaid billing and documentation |
| state Medicaid agency typically looks back three | | | | requirements, it can put you on par with the |
| years, then we typically would look back three | | | | MICs. Sanders says that for MICs to be effective, |
| years." But that's subject to change. | | | | they have to learn and understand the intricacies |
| The second rule: You should know the function of | | | | of every Medicaid program. |