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Audits and reviews of Medicaid providers in Alaska | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9
DHSS assists providers with several different audits and reviews, requested by different agencies to measure different things. Here is a key to the common reviews that occur in Alaska. If you are a provider and have any questions,  or have concerns about fraud or mistakes, please contact the DHSS Program Integrity Manager, [NAME], at [PHONE].
Name of audit: | Agency requesting audit: | Scope | What is measured by this audit: | What is reviewed | Subcontractor conducting audit: | Type of provider affected: | Number of providers affected: | Timeline | Other/notes; Contact info
Federal:
PERM: Payment Error Rate Measurement | CMS: Centers for Medicare and Medicaid Services | Nation-wide (federal) Medicaid | States’ rate of Medicaid payment errors | Review of Provider's Medical and Billing Records, State data processing and recipient eligibility | A+ Government Solutions and HealthDataInsights are the medical review contractors | All Alaska providers that bill Medicaid | 260 claims for Medicaid and 520 claims for DKC.  Plus 30 claim special batch for HCBW | Each State audited once every 3 years.  Alaska's next base period is 10/1/2013 - 9/30/2014. | [NAME], DHSS Program Integrity, 269-3020;                                            www.permaudit.alaska.gov/
Medicaid Integrity Program audits AKA Medicaid Integrity Contractor (MIC) audits | CMS: Centers for Medicare and Medicaid Services | Nation-wide (federal) Medicaid | Medicaid Overpayment Identification | Provider claims based on reviews by CMS review contractor | Health Management Services (HMS) DBA Integriguard | All Alaska providers that bill Medicaid | 3 Audits currently in progress | Annually, generally covering 2- 5 years of claims data | [NAME], DHSS Program Integrity Manager, 269-0361
Disproportionate Share Audit (DSH) | CMS: Centers for Medicare and Medicaid Services | Nation-wide (federal) Medicaid | Appropriateness of DSH Payments | States’ processes; Provider documentation | Myers & Stauffer | Hospitals receiving state DSH payments | Varies from year to year | Annually, start in July, end in September | [NAME], Office of Rate Review - 334-2466
Myers and [NAME] | Alaska State Legislature, via AS 47.05.200 | Statewide Medicaid | [NAME]  payments | Provider Claims | Myers and [NAME] | All Alaska providers | 80 per year | Annually covering 1 calendar year | [NAME], DHSS Program Integrity Manager, 269-0361
Financial statement and State and Federal Single Audit | Federal through OMB Circular A-133, State of Alaska through 2 AAC 45.010 and DHSS through 7 AAC 78.230 | Grantees subject to Single Audit requirement and Home and Community baset waiver providers | Compliance with applicable laws, regulations and grant provisions, accuracy of finacial reporting. | Accounting and program processes. | Independent CPA firms. | Providers that are grant funded and HCBW Providers | Most grant funded and HCBW proviers | Annually if provider meets single audit threshold. Otherwise, biennially. | [NAME], DHSS Grant Audit Manager, Single Audit Representative. [PHONE].
Cost report audit | Office of Rate Review | Desk review or field audit. Medicaid | Facility cost and statistics. | Medicare cost report/Medicaid forms. |  | Facilities (nursing homes, long-term care hospitals, etc) | All hospitals,  nursing homes and FQHC's | 1 to 4 year audit cycle. | [NAME], Office of Rate Review - 334-2466
Credit Balance Audit | DHSS Div of Health Care Services | Statewide Medicaid | Medicaid credit balances | Provider Claims | HMS | All Alaska Medicaid providers | All | Annually | Puni [NAME], HCS 334-2400
SURS audit | ACS | Statewide Medicaid | Medicaid payments, specifics vary by review | Provider Claims | Xerox at the direction of Health Care Services | All Alaska Medicaid providers | All | varies | [NAME] HCS 334-2430
Focused review or audit by  DHSS program integrity | DHSS | Statewide Medicaid | Medicaid payments, specifics vary by review | Varies by engagement |  | All Alaska Medicaid providers | All | varies | [NAME], DHSS Program Integrity Manager, 269-0361
Medicaid RAC | DHSS | Statewide Medicaid | Medicaid improper payments | Provider Claims | (HMS) Health Management System | All Alaska Medicaid providers | All | Contract start 7/01/12 | [NAME], DHSS Program Integrity Manager, 269-0361
Electronic Health Records Incentive payment audit | DHSS | Providers receiving E.H.R. incentive payments. | Incentive payment accuracy and eligibility. | Program eligibility and payment accuracy | Myers and [NAME] | All Alaska Medicaid providers receiving E.H.R. incentive payments | Providers receiving E.H.R. incentive payments | Program participation from January 2011 | [NAME], DHSS Program Integrity Manager, 269-0361