MIC Resources
Along with Recovery Audit Contractors (RACs), Medicaid Integrity Contractors (MICs) have also hit the spotlight. As part of the Deficit Reduction Act of 2005 (DRA), Congress required CMS to establish the Medicaid Integrity Program (MIP). A five year Comprehensive Medicaid Integrity Plan (CMIP) is updated annually to assist the MIP in operations and development. The most recent CMIP for FYs 2009-2013 was released in July. The CMIP provides background and an overview of planned activities for FY 2009 as well as future fiscal years.
Under the MIP, CMS must hire contractors to review provider activities, audit claims, identify overpayments and conduct provider education. Like the RACs, data will drive focus on aberrant billing patterns; however audit selection will also be based on referrals from state agencies.
The Audit MICs are contracted with CMS to perform audits of Medicaid providers. Audits have already begun in CMS Regions III and IV. CMS expects to have audits in place in all states and territories by the end of the year. MICs will be performing desk audits as well as field audits. All Medicaid providers are subject to these audits.
There has been speculation that the MIC audits may be more burdensome than the RAC audits. Some reasons for concern include: there are no published record request limits for review, no defined time period for look-back, the number of days a provider has to produce requested records is state based. CMS has indicated that providers will have at least 2 weeks to produce documents (much less than the 45 days allowed under RACs).
Make sure you are prepared for MIC audits the same way you are preparing for RAC audits. You should be conducting internal audits of your Medicaid claims to ensure compliance. More information for providers is expected to be available on the CMS website soon.
To view information about the MIP, go to: http://www.cms.hhs.gov/MedicaidIntegrityProgram/
To view the MIP Provider Audit Fact Sheet, go to: www.cms.hhs.gov/FraudAbuseforProfs/Downloads/mipproviderauditfactsheet.pdf
The current CMIP can be found at: http://www.cms.hhs.gov/DeficitReductionAct/02_CMIP.asp#TopOfPage
To view the CMIP review schedule for FYs 2009-2011, go to: Comprehensive Program Integrity Review Schedule FYs 2009-2011 [PDF, 16KB]
