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Healthcare Audits Helping organizations understand audit guidelines and requirements
Au·dit  :  efficiency check:  a systematic check or assessment, especially of the efficiency  or effectiveness of an organ...
Centers for Medicare and Medicaid Services <ul><li>Federal programs with the most improper payments (2008) </li></ul><ul><...
So many audits so little time…  Medicare <ul><li>QIO  (Quality Improvement Organization) </li></ul><ul><li>CERT  (Comprehe...
So many audits so little time…  Medicaid <ul><li>MIP  (Medicaid Integrity Program) </li></ul><ul><li>MFCU  (Medicaid Fraud...
Medicare – QIO  (Quality Improvement Organization) <ul><li>Quality Improvement Organization (QIO) contractor </li></ul><ul...
<ul><li>Step 1:  Regional Medicare carriers – pay claims </li></ul><ul><li>Step 2:  CERT – verify claims processing errors...
Medicare – CERT  (Comprehensive Error Rate Testing)  <ul><li>Monitors accuracy of the Medicare FFS program </li></ul><ul><...
Medicare – RAC  (Recovery Audit Contractor ) <ul><li>3 rd  highest federal program with most improper payments </li></ul><...
Schedule…  Implementation nationwide January 1, 2010
 
Medicare – ZPIC  (Zone Program Integrity Contractor) <ul><li>Combination of 2 previous audits…  </li></ul><ul><li>Program ...
<ul><li>Coordinate Medicare-Medicaid data matches (Medi-Medi) </li></ul><ul><ul><li>Partnership between states and CMS </l...
ZPIC Jurisdictions
Medicare – MAC  (Medicare Administration Contractor) <ul><li>Replace 48 FIs (Fiscal Intermediaries) –  23 MACs by 2011 </l...
Medicare – PSC  (Program Safeguard Contractor) <ul><li>Purpose to detect and deter fraud and abuse  </li></ul><ul><ul><li>...
Medicaid – MIP  (Medicaid Integrity Program) <ul><li>Established by the Deficit Reduction Act of 2005 </li></ul><ul><ul><l...
Medicaid – MIPs cont. <ul><li>Any provider who bills for Medicaid services can be audited </li></ul><ul><ul><li>Including ...
Medicaid – MIPs cont. - Process <ul><li>10 step process </li></ul><ul><ul><li>Identification of audits through data analys...
<ul><li>Measure improper payments </li></ul><ul><ul><li>Medicaid  </li></ul></ul><ul><ul><li>SCHIP (State Children’s Healt...
Medicaid – MFCU  (Medicaid Fraud Control Units) <ul><li>Program arose from the Medicare and Medicaid Anti-Fraud and Abuse ...
OIG  (Office of Inspector General) <ul><li>Combat fraud, abuse and waste of Medicare and Medicaid programs </li></ul><ul><...
FBI <ul><li>Receive referrals from the OIG </li></ul><ul><li>Handle Beneficiary Complaints </li></ul><ul><li>Only handle f...
Other Audits - Permedion <ul><li>Contract with Medicare, Medicaid and State Insurance Departments </li></ul><ul><li>Perfor...
Audit Limit Freq. MR Request  Response MR  Reimburse Discussion  Period Collect $ Appeal Rights Mult. Audits RAC 200 inpt ...
(RAC) Audit Administration Solution functionality <ul><li>Designed to manage the provider’s appeal process to the RAC audi...
OnBase RAC Administration Solution Webinars Monday Tuesday Wednesday Thursday Friday 1 4 5 6 7 8 11 12 General Audit  13 W...
References <ul><li>CMS releases details on 2009 permanent Recovery Audit Contractors (RACs) program. Retrieved Jan. 21, 20...
<ul><li>CMS RAC Review Phase-in Strategy (6/24/09).  Retrieved November 2, 2009.  http://www.cms.hhs.gov/RAC/Downloads/CMS...
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Healthcare audits: Helping organizations understand audit guidelines and requirements

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Healthcare audits: Helping organizations understand audit guidelines and requirements

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Healthcare audits: Helping organizations understand audit guidelines and requirements

  1. 1. Healthcare Audits Helping organizations understand audit guidelines and requirements
  2. 2. Au·dit : efficiency check:  a systematic check or assessment, especially of the efficiency or effectiveness of an organization or a process, typically carried out by an independent assessor Encarta® World English Dictionary [North American Edition] © & (P)2009 Microsoft Corporation. www.qualityimprovementconsulting.com/supplier...
  3. 3. Centers for Medicare and Medicaid Services <ul><li>Federal programs with the most improper payments (2008) </li></ul><ul><ul><li>#1 - Medicaid ($18.6 Billion) </li></ul></ul><ul><ul><li>#2 - Earned Income Tax Credit ($12.1 Billion) </li></ul></ul><ul><ul><li>#3 – Medicare ($10.4 Billion) </li></ul></ul><ul><li>CMS moving away from a single contractor to multiple single function contractors </li></ul><ul><li>Over 10 separate types of audits for healthcare organizations to track and provide information/responses </li></ul><ul><li>New update… Senate Healthcare Reform Bill </li></ul><ul><ul><li>Medicaid RAC by Dec. 31, 2010 </li></ul></ul><ul><ul><li>Expansion of Medicare RAC to Parts C & D </li></ul></ul>
  4. 4. So many audits so little time… Medicare <ul><li>QIO (Quality Improvement Organization) </li></ul><ul><li>CERT (Comprehensive Error Rate Test) </li></ul><ul><li>RAC (Recovery Audit Contractor) </li></ul><ul><li>ZPIC (Zone Program Integrity Contractors) </li></ul><ul><li>MAC (Medicare Administrative Contractors) </li></ul><ul><li>PSC (Program Safeguard Contractor) </li></ul><ul><li>OIG (Office of Inspector General Audits) </li></ul><ul><li>Goal = Protect the Medicare Trust Fund </li></ul>
  5. 5. So many audits so little time… Medicaid <ul><li>MIP (Medicaid Integrity Program) </li></ul><ul><li>MFCU (Medicaid Fraud Control Unit) </li></ul><ul><li>RAC (Recovery Audit Contractor) </li></ul><ul><li>Others…. Ancillary Audits </li></ul><ul><li>Permedion (Independent Medical Review Organization) </li></ul>
  6. 6. Medicare – QIO (Quality Improvement Organization) <ul><li>Quality Improvement Organization (QIO) contractor </li></ul><ul><ul><li>Improve effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries </li></ul></ul><ul><ul><li>Concentrate on overpayments concerning higher weighted DRGs </li></ul></ul><ul><ul><li>Tasked with oversight of the HACs (Hospital Acquired Conditions) </li></ul></ul><ul><ul><li>Link payments to quality </li></ul></ul><ul><ul><ul><li>Hospital Acquired Conditions (HACs) </li></ul></ul></ul><ul><ul><ul><li>National Coverage Decisions (NCDs) </li></ul></ul></ul><ul><ul><ul><ul><li>Never-Events (block Medicare payments for &quot;preventable errors and conditions“) </li></ul></ul></ul></ul>r.
  7. 7. <ul><li>Step 1: Regional Medicare carriers – pay claims </li></ul><ul><li>Step 2: CERT – verify claims processing errors by carriers </li></ul><ul><li>- Request additional documentation </li></ul><ul><li>- CERT contractor reviews services that are paid incorrectly </li></ul><ul><ul><ul><li>(Under or overpayments) </li></ul></ul></ul><ul><ul><ul><li>- Notifies Medicare contractor to adjust claim </li></ul></ul></ul><ul><li>Step 3: RAC review </li></ul><ul><li>- Provide independent oversight on CERTs </li></ul><ul><li>Step 4: PSC identify cases of suspected fraud </li></ul><ul><li>Step 5: OIG prosecutes fraud cases </li></ul><ul><li> - Criminal or civil, $ fines and/or administrative sanctions </li></ul>Medicare Claims Process…
  8. 8. Medicare – CERT (Comprehensive Error Rate Testing) <ul><li>Monitors accuracy of the Medicare FFS program </li></ul><ul><ul><li>Monthly random claims audit – processed correctly </li></ul></ul><ul><ul><li>Part A & B claims </li></ul></ul><ul><ul><ul><li>Observing all inpatient claims </li></ul></ul></ul><ul><ul><ul><li>Focusing on inpatient and outpatient consults (Cardiologists, Pulmonologists, Neurologists and Internal Medicine) </li></ul></ul></ul><ul><ul><ul><ul><li>Issues </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Consults should have been billed as visits </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Not enough documentation </li></ul></ul></ul></ul></ul><ul><ul><li>Audit frequently used codes </li></ul></ul><ul><ul><li>May request $ back from provider </li></ul></ul><ul><ul><li>MAC (Medicare Administrative Contractors) use the results </li></ul></ul>
  9. 9. Medicare – RAC (Recovery Audit Contractor ) <ul><li>3 rd highest federal program with most improper payments </li></ul><ul><ul><li>3 year pilot program (6 states participated) </li></ul></ul><ul><ul><ul><li>$1.3 billion in total improper payments identified </li></ul></ul></ul><ul><li>Correct improper payments under the Medicare Fee-For-Service program </li></ul><ul><li>Healthcare organizations targeted – Medicare Parts A & B </li></ul><ul><ul><ul><li>By Dec. 31 st , 2010 expansion to Medicare parts C & D </li></ul></ul></ul><ul><li>RACs are paid a % of the $$ they recoup </li></ul><ul><li>Anticipate permanent RAC to be more aggressive </li></ul><ul><li>OnBase RAC = AHA RACTrac Compatible Vendor </li></ul>
  10. 10. Schedule… Implementation nationwide January 1, 2010
  11. 12. Medicare – ZPIC (Zone Program Integrity Contractor) <ul><li>Combination of 2 previous audits… </li></ul><ul><li>Program Safeguard Contractor (PSC) + Medicare Drug Integrity Contractor (MEDIC) = Zone Program Integrity Contractor (ZPIC) </li></ul><ul><li>Oversee the RACs – help insure accuracy of the audits </li></ul><ul><li>Check for fraud for all Medicare claims </li></ul><ul><ul><li>Parts A & B (Hosp., HHC, DME, Providers and Skilled Nursing) </li></ul></ul><ul><ul><li>Part C (Managed Care) </li></ul></ul><ul><ul><li>Part D (Prescription Drug Plans) </li></ul></ul><ul><ul><li>5 states = “hot spot” zones (CA, FL, IL, NY and TX) </li></ul></ul><ul><ul><ul><li>Quick response to fraud and administrative actions </li></ul></ul></ul>
  12. 13. <ul><li>Coordinate Medicare-Medicaid data matches (Medi-Medi) </li></ul><ul><ul><li>Partnership between states and CMS </li></ul></ul><ul><ul><li>Match Medicare and Medicaid claim data to detect fraudulent patterns </li></ul></ul><ul><ul><li>Patterns appear when claims compared – difficult to identify separately </li></ul></ul><ul><ul><li>CMS coordinates with Program Safe Guard (PSCs) to complete Medi-Medi tasks </li></ul></ul><ul><ul><ul><li>Current Medi-Medi states </li></ul></ul></ul><ul><ul><ul><ul><li>WA, CA, TX, IL, OH, PA, NY, NJ, FL, NC </li></ul></ul></ul></ul><ul><ul><ul><ul><li>CMS will award (ZPICs) who will consolidate Medicare Parts A, B, C, D and Medi-Medi Benefit Integrity Activities </li></ul></ul></ul></ul>Medicare – ZPIC (Zone Program Integrity Contractor)
  13. 14. ZPIC Jurisdictions
  14. 15. Medicare – MAC (Medicare Administration Contractor) <ul><li>Replace 48 FIs (Fiscal Intermediaries) – 23 MACs by 2011 </li></ul><ul><ul><li>15 processing Parts A & B claims </li></ul></ul><ul><ul><li>4 processing DME claims </li></ul></ul><ul><ul><li>4 processing HHC and Hospice claims </li></ul></ul><ul><li>MACs look for coding errors… patterns </li></ul><ul><ul><li>Review outliers (compare to peers) </li></ul></ul><ul><ul><ul><li>Geographic location, state, nationally </li></ul></ul></ul><ul><ul><li>Focus on high $ codes (Reclast and Ultrasound) </li></ul></ul><ul><ul><ul><li>MACs do not receive % of $ saved </li></ul></ul></ul><ul><ul><li>Pre and Post payment reviews & Provider education </li></ul></ul><ul><ul><li>2 levels of appeal </li></ul></ul><ul><ul><li>Identify fraud & abuse – potential jail, fines/payback </li></ul></ul>
  15. 16. Medicare – PSC (Program Safeguard Contractor) <ul><li>Purpose to detect and deter fraud and abuse </li></ul><ul><ul><li>Review Medicare Parts A & B </li></ul></ul><ul><ul><li>Obtain and review info from RAC auditors for suspected fraud </li></ul></ul><ul><ul><li>PSCs analyze data </li></ul></ul><ul><ul><ul><li>Moving beyond capabilities of MACs/FIs </li></ul></ul></ul><ul><ul><li>Refer cases to OIG </li></ul></ul><ul><ul><ul><li>Possibly FBI </li></ul></ul></ul><ul><ul><li>May also refer cases to law enforcement </li></ul></ul>
  16. 17. Medicaid – MIP (Medicaid Integrity Program) <ul><li>Established by the Deficit Reduction Act of 2005 </li></ul><ul><ul><li>Contractors hired to… </li></ul></ul><ul><ul><ul><li>Review provider actions </li></ul></ul></ul><ul><ul><ul><li>Audit claims / Identify overpayments (Claim error rate 10.5%) </li></ul></ul></ul><ul><ul><ul><li>Provide education about program integrity issues </li></ul></ul></ul><ul><ul><li>First federal program to perform Medicaid provider audits </li></ul></ul><ul><ul><ul><li>- Identify inappropriate payments and fraud </li></ul></ul></ul><ul><li>Contractors used (private companies) </li></ul><ul><ul><li>Medicaid Integrity Review Contractors (Review MICs) </li></ul></ul><ul><ul><li>Medicaid Integrity Audit Contractors (Audit MICs) </li></ul></ul><ul><ul><ul><li>Most activity – can perform onsite reviews </li></ul></ul></ul><ul><ul><ul><li>Expected to recover more $ than the Medicare RACs </li></ul></ul></ul><ul><ul><li>Medicaid Integrity Education Contractors (Education MICs) </li></ul></ul>
  17. 18. Medicaid – MIPs cont. <ul><li>Any provider who bills for Medicaid services can be audited </li></ul><ul><ul><li>Including managed care organizations and fee for service providers </li></ul></ul><ul><ul><li>Utilize statistical data to target claims and identify potential overpayments – </li></ul></ul><ul><ul><li>Identified by referrals or by the state </li></ul></ul><ul><li>No limited look back period </li></ul><ul><ul><li>No limit on medical record requests (different from RAC) </li></ul></ul><ul><ul><ul><li>Can look back as far as the state Medicaid agency </li></ul></ul></ul><ul><ul><li>Document submission to the auditor - approximately 2 weeks </li></ul></ul><ul><ul><li>No reimbursement for copies of medical records </li></ul></ul><ul><li>State is responsible for collecting payments </li></ul><ul><ul><li>Federal govt. will collect $ from the state </li></ul></ul>
  18. 19. Medicaid – MIPs cont. - Process <ul><li>10 step process </li></ul><ul><ul><li>Identification of audits through data analysis </li></ul></ul><ul><li>Entrance conference scheduled </li></ul><ul><li>Notification letters – contact info at Audit MIC </li></ul><ul><li>Audit MIC – audit report given to state, then provider </li></ul><ul><ul><li>Each reviews report – can comment of findings </li></ul></ul><ul><ul><li>CMS will review info and initiate revised draft report </li></ul></ul><ul><ul><li>Report given back to state to review and make comments </li></ul></ul><ul><ul><li>State will collect identified overpayments </li></ul></ul><ul><ul><li>Providers will have appeal rights </li></ul></ul>
  19. 20. <ul><li>Measure improper payments </li></ul><ul><ul><li>Medicaid </li></ul></ul><ul><ul><li>SCHIP (State Children’s Health Insurance Program) </li></ul></ul><ul><li>Comply with Improper Payments Information Act of 2002 </li></ul><ul><li>3 contractors, performing several tasks… </li></ul><ul><ul><li>Statistical calculations </li></ul></ul><ul><ul><li>Medical records collection </li></ul></ul><ul><ul><li>Medical/data processing review of selected State Medicaid and CHIP FFS and managed care claims </li></ul></ul><ul><li>Most identified errors due to documents not submitted by deadlines </li></ul>Medicaid – PERM (Payment Error Rate Measurement)
  20. 21. Medicaid – MFCU (Medicaid Fraud Control Units) <ul><li>Program arose from the Medicare and Medicaid Anti-Fraud and Abuse Amendments of 1977 </li></ul><ul><ul><li>Authorized the establishment and Federal funding for the State Medicaid Fraud Control Units (SMFCUs) </li></ul></ul><ul><ul><li>49 states and the District of Columbia participate in the program through their SMFCUs </li></ul></ul><ul><ul><li>Mission is to investigate and prosecute Medicaid provider fraud and incidences of patient abuse and neglect </li></ul></ul><ul><ul><li>Investigative arm of the state Medicaid agency </li></ul></ul>
  21. 22. OIG (Office of Inspector General) <ul><li>Combat fraud, abuse and waste of Medicare and Medicaid programs </li></ul><ul><li>Obtain and process referrals </li></ul><ul><ul><li>May seek… </li></ul></ul><ul><ul><ul><li>Criminal or civil prosecution </li></ul></ul></ul><ul><ul><ul><li>Monetary penalties </li></ul></ul></ul><ul><ul><ul><li>Administrative sanctions </li></ul></ul></ul><ul><ul><li>Responsible for looking at Fraud </li></ul></ul><ul><ul><ul><li>Enforce accuracy in payment </li></ul></ul></ul><ul><ul><li>- Will ask for records/documentation – in most cases </li></ul></ul><ul><ul><li>They can utilize the FBI, if needed </li></ul></ul>
  22. 23. FBI <ul><li>Receive referrals from the OIG </li></ul><ul><li>Handle Beneficiary Complaints </li></ul><ul><li>Only handle fraud investigations/cases </li></ul><ul><ul><li>Private and public healthcare programs </li></ul></ul>
  23. 24. Other Audits - Permedion <ul><li>Contract with Medicare, Medicaid and State Insurance Departments </li></ul><ul><li>Perform external and independent medical review services, to ensure: </li></ul><ul><ul><li>Right care </li></ul></ul><ul><ul><li>Right setting </li></ul></ul><ul><ul><li>Services billed correctly </li></ul></ul><ul><ul><li>Verify provider credentials – Quality care and services </li></ul></ul>
  24. 25. Audit Limit Freq. MR Request Response MR Reimburse Discussion Period Collect $ Appeal Rights Mult. Audits RAC 200 inpt 45 days 45 days $0.12/page 15 days 41 st day 5 levels No MAC Unknown Unknown Unknown Unknown Unknown Unknown 2 levels Unknown PERM Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown ZPIC Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown CERT None Any 30 days None Unknown State Regulated 2 levels Yes PSC Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown MIC/MIP None State Regulated State Regulated None State Provider MIC State CMS State Regulated State Regulated Yes MFCU Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Permedion None Any 30 days N/A State Regulated State Regulated 2 levels Yes
  25. 26. (RAC) Audit Administration Solution functionality <ul><li>Designed to manage the provider’s appeal process to the RAC auditor and the denial of medical claims </li></ul><ul><ul><li>Management of inpatient and outpatient claims </li></ul></ul><ul><ul><li>Task Management </li></ul></ul><ul><ul><ul><li>Track responsible employee assigned to each task </li></ul></ul></ul><ul><ul><ul><li>Notifications / reminders </li></ul></ul></ul><ul><ul><li>Configurable Parameters </li></ul></ul><ul><ul><li>Tracking functionality </li></ul></ul><ul><ul><ul><li>Shipping information </li></ul></ul></ul><ul><ul><ul><li>Expected completion dates / appeal timelines </li></ul></ul></ul><ul><ul><ul><li>Medical record request costs </li></ul></ul></ul><ul><ul><ul><li>Interest due on recovered funds </li></ul></ul></ul><ul><ul><ul><li>Communication with RAC personnel </li></ul></ul></ul><ul><ul><li>Upload Claim History </li></ul></ul><ul><li>Dashboard Views: </li></ul><ul><li>Administration/Management </li></ul><ul><li>Financial </li></ul><ul><li>Risk Analysis </li></ul><ul><li>Process Improvement </li></ul>
  26. 27. OnBase RAC Administration Solution Webinars Monday Tuesday Wednesday Thursday Friday 1 4 5 6 7 8 11 12 General Audit 13 Webinar 12pm EST Register Here 14 RAC Solution Demo 15 3pm EST Register Here 18 19 20 7 Steps 21 Webinar 3pm EST Register Here 22 25 RAC Solution Demo 26 3pm EST Register Here 27 28 29
  27. 28. References <ul><li>CMS releases details on 2009 permanent Recovery Audit Contractors (RACs) program. Retrieved Jan. 21, 2009. http://www.mgma.com/policy/default.aspx?id=23052 </li></ul><ul><li>Frequently Asked Questions. (Jan. 25, 2008). Retrieved Jan. 21, 2009, from http://www.aha.org/aha/content/2008/pdf/080125-racfaq.pdf </li></ul><ul><li>Healthcare Compliance Quarterly Insights: Surviving RAC. Retrieved Jan, 22, 2008. http://www.hfma.org/forums/healthcare/Healthcare_Compliance_Tips_RAC_Audit.htm </li></ul><ul><li>Center for Medicare & Medicaid Services (CMS) Recovery Auditor Contractor (RAC) Program, AAHAM Position. Retrieved 12/1/2008. http://www.txaaham.org/files/AAHAM%20Position%20Paper%202008.pdf </li></ul><ul><li>Pennsylvania Physicians Facing CERT Audits . http://www.pamedsoc.org/CERT </li></ul><ul><li>How to Survive a Medicare Audit. (May, 16, 2009). Retrieved October 13, 2009 from http://www.aace.com/advocacy/socio/HowtoSurviveaMedicareAudit.pdf </li></ul><ul><li>Legal Note: Medicaid Integrity Contractors. (August 17, 2009). Retrieved October 13, 2009 from http://www.arkhospitals.org/Legal%20Note%20Archive.pdf/08-17-09%20Legal%20Note.pdf </li></ul><ul><li>Medicaid Integrity Program Provider Audit Fact Sheet (November 2008). Retrieved October 13, 2009 from http://www.aparx.org/members/documents/MIPprovauditfactsheet-Nov2008.pdf </li></ul><ul><li>Potential NCD Topics (July 30, 2008). Retrieved November, 2, 2009 from http://www.cms.hhs.gov/mcd/ncpc_view_document.asp?id=19 </li></ul><ul><li>Office of Inspector General News (December 3, 2009). Retrieved December 11, 2009. http://oig.hhs.gov/w-new.asp </li></ul><ul><li>Medicaid Integrity Program (MIP), Provider Audits Frequently Asked Questions (July 2009). Retrieved December 11, 2009. http://www.dpw.state.pa.us/Resources/Documents/Pdf/MIP_Provider_Audits_FAQs.pdf </li></ul>
  28. 29. <ul><li>CMS RAC Review Phase-in Strategy (6/24/09). Retrieved November 2, 2009. http://www.cms.hhs.gov/RAC/Downloads/CMS%20RAC%20review%20strategy.pdf </li></ul><ul><li>Medicare-Medicaid Data Match Program . Retrieved November 3, 2009. </li></ul><ul><li>nampi.org/members/2007presentations/MediMedi.pps </li></ul><ul><li>Hospital Payment Monitoring Program (HPMP) Compliance Workbook (January 2006). Retrieved November 4, 2009. http://www.hpmpresources.org/Portals/1/Tools/HPMPCompWkbk_03-2008.pdf </li></ul><ul><li>“ Data mining programs” intensify scrutiny of Medicare claim.   National Psychologist, Vol. 17, No. 5, p. 9.. Retrieved November 5, 2009. http://www.centerforhealthyaging.com/Medicare_Audits_NP.htm </li></ul><ul><li>Medicaid Integrity Program A to Z. Retrieved November 6, 2009. www.wsha.org/files/119/MIP_A_to_Z_for_Providers_Aug%2009.pdf </li></ul><ul><li>Medicare Coverage Determination Process (6/08/2009). Retrieved November 10, 2009. http://www.cms.hhs.gov/DeterminationProcess/ </li></ul><ul><li>Quality Improvement Organizations (7/02/2009). Retrieved November 10, 2009. http://www.cms.hhs.gov/QualityImprovementOrgs/ </li></ul><ul><li>Senate Reform Bill Would Expand RAC Program (11/24/09). Retrieved November 25, 2009. http://www.healthleadersmedia.com/content/242585/topic/WS_HLM2_FIN/Senate-Reform-Bill-Would-Expand-RAC-Program.html </li></ul><ul><li>Medicaid Fraud & Abuse: A New Era of Federal and State Enforcement (10/9/09). Retrieved Dec 9, 2009. http://wwww.healthlawyers.org_Events_Programs_Materials_Documents_FC09_smith_slides.pdf </li></ul><ul><li>  </li></ul>References continued…
  29. 30. time to make a difference.

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