More Than Just RACs: Hospital Shares Its MIC Experience

James Carroll, May 20, 2010

As MIC audits begin to hit home with providers, the initial doubts and concerns that came earlier in the year have yet to subside. In fact, to borrow a line from The Carpenters, you may say "we've only just begun."

Unlike RACs, which had a demonstration period and received more sustained publicity, MICs have proceeded largely under the radar of many organizations. As a result, providers may be surprised and unprepared for the MIC audits. And even if they are prepared, the requests can be difficult to process.

"To start, we got requests from the MICs that had missing information," says Keisha Patterson, RAC coordinator at Saint Joseph's Hospital of Atlanta. "And these requests were on paper spreadsheets, so I had to request that the MIC send a workable electronic file."

After receiving the electronic information two days later, Patterson began matching patient account numbers to the requests with missing information.

"I had to go into our system manually and cross-match, have HIM get the medical records, pull UBs and remits—some of which were in print form and had to be removed from boxes—and so on, all while adhering to this 15-day limit for a response."

There was also confusion about the dollar amounts of some requests, which may leave providers wondering why so much time and energy is focused on so little.

"Some of the accounts the MIC was requesting were for about $2 because some of the accounts were Medicaid secondary and Medicare primary," says Patterson. "More than 50% of the accounts requested were Medicaid secondary, so half of these requests were for co-insurance payments."

However, it is not always the fault of the contractor. MICs, RACs, and other auditors obtain their information from a huge data warehouse via CMS, so the mistake may not be their own. Contractors are, in fact, there to help and to avoid provider abrasion, according to Patterson, who worked for a RAC for three years during the demonstration period. So keep in mind that the MIC is not out to get you, and that communication is important to ensuring the best possible process for your facility.

The first thing a provider should do during this process is to notify the MIC of who the primary contact at the facility is—and confirm it, says Patterson.

"We notified our MIC that I was the primary contact, and the requests were still sent to the CFO because that's where cost report-related information is sent," she explains. "If you only have 15 days to respond (opposed to the 120 days MICs are given to review the records) and it ends up in another office and not attended to right away, could you imagine seven days getting knocked off of 15?"

You may also consider asking for an extension. A MIC will not be proactive and ask whether you need one but, if you reach out, extensions are permissible, according to Patterson.

"Some people are scared to talk to contractors. They just think they have to send the records in x amount of time, but they are flexible," says Patterson, whose own MIC audits are currently in the 120-day review period. "You just have to reach out and tell them what you need done."

James Carroll James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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