Medicaid Integrity Contractor Audit Response

Hospitals across the country are experiencing governmental audits from the Medicare program. The program calls for Recovery Audit Contractors (RACs) to audit claims and medical records for improper coding or payments. The hospital industry is now gearing up for the next wave of audits for the Medicaid program that will be completed by Medicaid Integrity Contractors (MICs).;This project involved evaluating the Cincinnati Children's Hospital Medical Center's current process in response to governmental audits. Issues were identified such as the decentralized approach of managing audits between departments and the need to report audit activities to senior leadership. The project includes: · Development of an audit response team to track timely and complete audit responses, analyze patterns of denials, and identify opportunities for improvement. · A revision to the hospital's coding compliance plan that includes monitoring high risk audit targets. · Development of an executive dashboard report that summarizes audit activities for hospital leadership.