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Minnesota Department of Human Services Recovery Audit Contract (RAC) Provider Outreach & Education Presentation April 18, 2013. Agenda. Introduction HMS Overview Minnesota’s Medicaid RAC Program Complex and Credit Balance Reviews: Methodology Approach & Overview Review Process
Recovery Audit Contract (RAC)
Provider Outreach & Education Presentation
April 18, 2013
Approach & Overview
Collaboration with Minnesota
payment that cannot be automatically validated
providers to communicate:
MN RAC toll free number: 855-394-8063
Questions for DHS may be sent via email to [email protected]
Review Draft Audit Findings and respond within 30 calendar days of signed receipt of letter
If in agreement with findings remit payment within 30 days
If not in agreement with findings, submit a request for reconsideration within 30 days
Review Final Calculation of Overpayment letter and:
Agree and proceed with repayment, or
File an appeal within 30 days
14 years of experience working with providers on credit balance audit projects
Credit Balances Audits (CBAs) are focused on financial reimbursements to the provider
Primarily the CBAs are focused on reviewing the Provider’s Accounts Receivables (AR), Remittance Advices (RA), Explanation of Benefits (EOB) and miscellaneous relevant financial documents.
Experience determining and communicating with the provider the root cause of the identified overpayments or accounts resulting in credit balancesHMS Credit Balance Audit (CBA) Overview
Just because an account is sitting in a credit balance does not mean money is due back to the payer
Common causes of credit balance include:
Payments from third party payors and from Medicaid
Duplicate Medicaid payments
Duplicate adjustments made to an accountWhat is a Credit Balance?
Not all overpayments are credit balances; not all credit balances are overpayments
HMS provides a root cause analysis to prevent future credit balances.
Review all active and inactive accounts in credit balance status as of the notice date
Provider Self Disclosure
Review and Finalize findings
Provider Attestation Process
Recovery and ReportingCredit Balance Audits: Process Overview
Root cause analysis assists providers in preventing future overpayments
Insure providers are up to date on the latest billing and reimbursement methods utilized by MN DHSCredit Balance: Provider Education
Secure website for each provider to manage reviews