Tip #7: Avoiding Medicaid Recoupments

Health care providers: In case you haven’t noticed, currently, the State is barreling through Medicaid audits. If you are a health care provider who has received a Tentative Notice of Overpayment, then you know how many trees the State is killing. These Notices are NOT short.  Many Notices are hundreds of pages and claim that the health care provider owes hundreds of thousands, some even millions, of Medicaid payments back to the State.  Obviously, this is extremely daunting to the health care provider. Paying hundreds of thousands of dollars to the State, in many cases, would put the provider out of business.  The providers need the Medicaid reimbursements to pay staff and keep their doors open.

So, how can you avoid the Tentative Notice of Overpayment? If you’ve read my past “Tips for Avoiding Medicaid Recoupments,” then you know that organization of your documents is key. The details, the small details, are the big mistakes, i.e., the dates are correct, the times in and out are recorded, the signatures are legible, etc.

Today’s tip is a bit more expensive, but will pay for itself by the Tentative Notices of Overpayment that you do not get, the lawyers you do not hire, and the hours of stress that you do not undergo because you were proactive at the onset.

If you have not already, health care providers, invest in a computer program designed specifically for health care providers who accept Medicaid. If you already have a computer program, great! You are on your way to running an audit-less company.

If you are still submitting paper documents to the State, you are not alone. Most health care providers have not invested in a computer program to go “paperless.” It is an expensive endeavor. But with the scrutiny in which the State places on the documentation  for Medicaid, a good computer system is worth its weight in gold.

However, make sure the computer program:

1. is designed for North Carolina Medicaid.

2. has the capacity to hold the large number of documents for a long time.

3. is organized in a way that you can find any documents quickly and easily.

4. is affordable.

5. has reputable client support.

So how do you find the right one? If you have googled computer systems for Medicaid providers, I’m sure you were as confused as I was. Not to mention, probably terrified once you read that NC State paid $122 million to HP for its contract extension.

Not to fear: There are  numerous affordable computer software programs for health care providers. I suggest two things: (1) Ask other health care providers what software they use and whether they like the service; (2) Call between 5-10 software companies and ask them to send a sales rep to your office to explain what the software can do for you. By asking around and having reps come explain the systems, you will have enough knowledge to determine which software package is right for you.



About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on January 22, 2013, in Division of Medical Assistance, Health Care Providers and Services, Medicaid, Medicaid Appeals, Medicaid Recipients, Medicaid Recoupment, Medicaid Reimbursement, NC DHHS, North Carolina, Reconsideration Reviews, Tentative Notices of Overpayment and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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