Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.85 - GENERAL MEDICAID SERVICES › Subchapter 37.85.4 - Provider Requirements › Rule 37.85.414 - MAINTENANCE OF RECORDS AND AUDITING

Current through Register Vol. 13, July 5, 2024
(1) All
				providers of service must maintain records which fully demonstrate the extent,
				nature and medical necessity of services and items provided to Montana Medicaid
				recipients. The records must support the fee charged or payment sought for the
				services and items and demonstrate compliance with all applicable requirements.
(a) All records which support a claim for a
				service or item must be complete within 90 days after the date on which the
				claim was submitted to Medicaid for reimbursement. A record that is required to
				be signed and dated, including but not limited to an order, prescription,
				certificate of medical necessity, referral or progress note, is not complete
				until it has been signed and dated.
(b) When reimbursement is based on the length
				of time spent in providing the service, the records must specify the time spent
				or the time treatment began and ended for each procedure billed to the nearest
				minute. Total time billed using one or multiple procedure codes may not exceed
				the total actual time spent with the Medicaid client.
(c) These records must be retained for a
				period of at least six years and three months from the date on which the
				service was rendered or until any dispute or litigation concerning the services
				is resolved, whichever is later.
(d) In maintaining financial records,
				providers shall employ generally accepted accounting methods. Generally
				accepted accounting methods are those approved by the National Association of
				Certified Public Accountants.
(e)
				The department shall have access to all records so maintained and retained
				regardless of a provider's continued participation in the program.
(f) In the event of a change of ownership,
				the original owner must retain all required records unless an alternative
				method of providing for the retention of records has been established in
				writing and approved by the department.
(g) If a provider cannot provide medical
				records to prove that a service billed to Medicaid was provided and meets all
				requirements for reimbursement, the service will be deemed not to be provided
				and reimbursable due to the lack of documentation, and the department will
				recover all reimbursement paid to the provider. This recovery is permissible
				regardless of whether the documentation was destroyed or lost due to an event
				such as, but not limited to, misplaced records, a data processing failure,
				fire, earthquake, flood, or other natural disaster. The provider must have a
				backup system in place to allow recovery of documentation destroyed or lost due
				to such events or any other cause.
(h) These record keeping requirements are the
				minimum requirements for records to support all Medicaid claims. In addition to
				complying with these minimum requirements, providers must also comply with any
				specific record keeping requirements applicable to the type of service the
				provider furnishes, which may be more restrictive than the minimum requirements
				of this rule.