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Medicare Administrative Contractors: Audit Trend

How to Protect Dual Eligible Reimbursement from Audit Scrutiny

In the past year, there has been a new audit trend emerging amongst MACs (Medicare Administrative Contractors). In some cases, this trend has led to significant decreases in crossover reimbursement due to audit adjustments.

Adjustments are occurring when providers are unable to support and prove Medicaid was re-billed after Medicare recouped and reissued a claim. This explains why Medicare Administrative Contractors are requesting account histories & all Medicaid remits during audit.

In a previous article Blue released, we discussed the importance of rebilling Medicaid after Medicare recoups and reissues a claim. They DO NOT automatically cross back over to Medicaid. Responsibility thus lies with the provider to ensure Medicaid is re-billed. This has put an additional burden on providers, as rebilling Medicaid is a manual process.

Unfortunately, it appears that this audit trend will be sticking around for the foreseeable future. Crossover bad debts can be the greater part of a provider’s reimbursement, therefore protecting these dollars from audit scrutiny is more important than ever.

Key Questions to Ask Your Team:

As your organization starts to think about how you will be dealing with this new audit trend, our team came up with two questions you should be discussing.

  1. Are you re-billing Medicaid when there is a recoupment or reissuance of a Medicare claim?
  2. Are all Medicaid remittances retained, including denials?

To safeguard & maximize your Medicare bad debt reimbursement or for more information, please contact your local Blue & Co. advisor.

About Blue and Co., LLC

At Blue & Co., we all have something in common. We didn’t get into this field because we love numbers and spreadsheets – although we definitely do – we got into this field because we love helping others. We’re driven by the impact that our work can have on our teammates, our clients, and our community.

It’s our mission to learn about what keeps you up at night and find ways to give you peace of mind. Because for us, it’s all about your success. Genuinely. We know that what we do is about more than simply helping to ensure the success and profitability of your organization.

It’s also about finding ways to help you achieve personal, financial, and life goals. And when you achieve those goals, you better believe we’re over here doing cartwheels to cheer you on.

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