Medicaid Recovery Audit Contractor Audits
Page Updated: April 22, 2024
CHA Advocacy Principle: Doctors and hospitals are committed to compliance and stewardship of Medicaid dollars; however, audits are incredibly time consuming, especially when they are driven by financial scavenger hunts, not patient needs. Audits should be warranted, effective, and efficient.
What Has Been Completed:
Origin: The Affordable Care Act requires states to contract with an outside vendor to review provider claims and propose/complete audits to detect and address Medicaid overpayments.
Background: There has been an uptick in audit activity and concerns that it is occurring without transparency and accountability from HCPF at a time when hospitals and doctors continue to face significant capacity challenges. In 2023, CHA worked with the General Assembly to pass House Bill (HB) 23-1295 to make several changes to reviews and audits of payments to providers by HCPF and associated processes to recover overpayments or reimburse providers for underpayments.
Outstanding Items:
The bill requires the office of the state auditor to conduct a comprehensive audit to review Colorado’s Medicaid RAC audit practices. Additionally, HCPF must hold quarterly provider convening meetings and trainings, create a RAC provider advisory group, and publish audit activity reports. The state auditor has contracted with BerryDunn to perform the audit. The final audited is expected in June 2024.
Resources:
Meetings/Dates of Note:
- April 25, 2024 – HCPF RAC Provider Advisory Board Meeting – register here
- May 2, 2024 – HCPF Quarterly Provider Meeting
- May 15, 2024 – CO Rac 101 Complex Training – register here
- June 27, 2024 – HCPF RAC Provider Advisory Board Meeting – register here
- June 2024 – Final Audit Expected
- Aug. 1, 2024 – HCPF Quarterly Provider Meeting
- Aug. 22, 2024 – HCPF RAC Provider Advisory Board Meeting – register here
- Nov. 13, 2024 – HCPF Quarterly Provider Meeting
- Dec. 12, 2024 – HCPF RAC Provider Advisory Board Meeting – register here
CHA Staff Contact: Megan Axelrod, CHA director of regulatory policy and federal affairs, [email protected]