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Dr. Meeske
Credit: ADA

The subject of Medicaid RAC audits found its way into the conversation at the recent roundtable meeting entitled “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations,” hosted by the U. S. Senate Special Committee on Aging.

Jessica Meeske, DDS, a dentist who serves Medicaid patients in rural Nebraska, related the story of the first Medicaid RAC audit by the Medicaid auditor HMS for her practice, as well as three hundred other dental providers in Nebraska, in the first week of April.

Roughly 1,000 claims, all representing $22 fees for periodic routine dental cleanings, were erroneously reviewed based on the frequency of services. While the standard frequency for these services in the state of Nebraska is stated as a six-month interval, Nebraska’s Medicaid regulations ultimately leave the frequency of services up to the provider. This allows dentists to take into account patients with more serious dental conditions, as well as the distance traveled by Nebraska Medicaid recipients to an appointment with a participating provider.

All of the cases pulled from Dr. Meeske’s practice represented services that were provided one day prior to a full six-month period.  The administrative burden encountered required the assignment of one dental hygienist for a full week in order to pull the records related to these visits.

In the wake of this audit process, referred to as “cumbersome” and “burdensome” by Dr. Meeske, a level of mistrust has now developed between the state Medicaid agency and the dentists of Nebraska, who are attempting, despite multiple obstacles, to provide quality care for all who seek it.

Despite this rather negative first experience with Medicaid RAC audits, Dr. Meekse stated that she was not opposed to audits in a general sense, as long as audits are “reasonable, fair and helpful,” she added. Dr. Meekse also expressed a desire for audits that are performed in a collaborative, prospective fashion that clarify areas of confusion in Medicaid regulations. 

The hearing took place on the same day as the release of a report by the Government Accountability Office (GAO). This report, entitled “Improper Payments: Government-Wide Estimates and Reduction Strategies”, indicated an estimated Medicaid error rate of 5.8 percent, or $14.4 billion.

While the GAO report was short on specific recommendations for reducing Medicaid improper payments, mention was made of diagnosis coding errors being a root cause of improper payments by Medicaid. The report also highlighted the Centers for Medicare & Medicaid Services’ (CMS) relatively new use of predictive analytic technology as something that could benefit other federal government departments in reducing improper payments. 

The report also highlighted the more than 4,000 state employees that have been offered training at the Medicaid Integrity Institute, located on the campus of the University of South Carolina in Columbia.

About the Author

J. Paul Spencer, CPC, CPC-H, is the director of regulatory and coding compliance at Providence Hospital in Washington, DC. He is a member of the RACmonitor editorial board and is a popular contributor to Monitor Mondays.

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J. Paul Spencer, CPC, COC

J. Paul Spencer is a senior healthcare consultant for DoctorsManagement. Is the national correspondent for Monitor Mondays, the live Internet radio broadcast produced by RACmonitor.

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