Providers Seek Information on Medicaid Integrity Contractors

What are MICs looking for? Again, this differs from state to state. One provider indicated evaluation and management (E/M) codes were audited in her hospital's clinic areas. "When MICs found a preponderance of higher codes that didn't exactly meet the bell curve, they asked for the documentation for the higher levels. And we had to produce it all."

RACs may also audit E/M codes, but they have chosen to begin with more straightforward, automatic reviews. In addition, at least for Medicare Part B physician claims, CMS has indicated it will work closely with the AMA and the physician community prior to any E/M level auditing and will provide notice to the physician community before the RACs begin E/M audits.

Providers need to figure out how to meet MIC record requests and appeal deadlines. And surely they'd appreciate learning about MIC target areas. But again, information is difficult to come by, and much of it will differ from state to state, making the process that much more complex.

But as one provider said: "MICs are aggressive here. Very, very aggressive. And we're really being pushed."
So providers need to learn all they can, however they can, and as soon as they can about Medicaid Integrity Program audits to help them prepare.

Editor's note: For more on Medicaid audit activities, consider attending the upcoming to the upcoming HCPro audio conference, "Medicaid Integrity Contractor Audits: Know What to Expect and How to Prepare," to be held October 15. Speakers include James G. Sheehan, the New York State Medicaid Inspector General, and Sarah Kay Wheeler, partner at King & Spaulding in Atlanta.