[Name of the Writer]

[Name of the Institution]

[Subject]

[Date]

Medical Errors Audit Program

Introduction

The main purpose of this paper is to analyze the CMS recovery audit program for the issue of improper payments in Medicare. The issue of improper payments has increased with a huge rate. There are different reasons behind the issue of improper payments including the lack of audit and lack of proper technology. In this project, a governmental audit response plan will be developed. The plan includes major tasks to reach the goal of minimizing exposures to denials, reduced reimbursement, and compliance issues. A coding compliance plan with accompanying audit work plan and trending reports will give the hospital a process to follow to improve coding accuracy. A reporting dashboard will be developed that summarizes major auditing indicators including the total number of audits, number of records retrieved, percent of denials, and percent of successful appeals.

Discussion

The Medical Integrity Program (MIP) created by the Centers for Medicare and Medicaid Services (CMS) is being phased in across the United States. Hospitals must implement preventive measures to mitigate risks of large dollar recoupment by developing processes to track timely and complete responses, analyzing audit results, and identifying opportunities for education and improvement. This literature review will examine the history of Medicaid and the MIP, the Medicaid auditing process and hospital's response, tools for looking at data relationships and trends, and the use of coding compliance programs to improve audit outcomes (American Health Information Management Association, 71).

Medicaid

The act of Medicare or it can be said that Medicaid Act has been enacted in Title XVIII. This act has been enacted in 1965 as the Social Security Act. The act has been passed by President Lyndon B. Johnson. Medicaid is jointly funded by the federal government and the states but administered by the states. Each state has unique policies and procedures guiding their Medicaid program (Centers for Medicare and Medicaid Services [CMS], 2010). The main authorizers of the Medicaid program are Title XIX of the Act. The main purpose of this act was to facilitate the healthcare services to the children belonging to low-income group and do not have any parental suppot, or the support of any elderly.

The Medicaid Integrity Program

The process which has been used for the creation of MIP was the act of Deficit Reduction Act (DRA) which has been developed in 2005 and have been signed in 2006. Section 6034 of this legislation created the MIP through section 1936 of the Act and gave the Secretary of Health and Human Services (HHS) increased funding to combat Medicaid provider fraud, waste, and abuse through this program. An organized approach for responding to MIC audits includes developing an oversight group, developing processes to track timely and complete responses, analyzing patterns of errors and audit results, and identifying opportunities for education and improvement. The American Health Information Management Association (AHIMA) developed a document to assist hospitals in preparing for the Medicare audits conducted by Recovery Audit Contractors (RACs) that can be modified for the MIC ...