Government Audit Guidance

The CECP facilitates the processing and response to external audit and investigation requests. We will appeal requests for repayment, if supported by our internal review, and in agreement with the targeted service or physician. In order to do so, we:

  • review billing processes and documentation
  • draft discussion letters, appeal letters and other appropriate correspondence
  • facilitate extensions, as needed
  • communicate with the payor for any clarification needed

 

Note: It is important to promptly and accurately act upon correspondence from governmental or other external entities. If a Provider or Department employee receives this type of correspondence, it should be presented promptly to the Department Manager for reporting and forwarding to the Compliance Office. Correspondence may come from the following entities:

Entity

What it is

URL

Centers for Medicare and Medicaid Services

U.S. Government healthcare insurer

http://www.cms.gov/

Health Data Insights (HDI)

Recovery Auditor, Region D, Medicare Parts A and B

https://racinfo.healthdatainsights.com/

Strategic Health Solutions, LLP

Supplemental Medical Review Contractor (SMRC) 

http://www.strategichs.com

Noridian Administrative Services, Inc

Medicare Administrative Contractor or “MAC”), Region JE, Medicare Parts A and B, DME)

https://www.noridianmedicare.com/

Livanta - BFCC - QIO

AdvanceMed

Beneficiary and Family Centered Care/Quality Improvement Organization (BFCC-QIO)

Comprehensive Error Rate Testing Contractor (CERT), Medicare parts A and B

https://bfccqioarea5.com/provider.html

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/InformationforProviders.html

Department of Healthcare Services, California

Medi-Cal

http://www.dhcs.ca.gov/Pages/default.aspx

DHS, Office of Department of Health and Human Services Office of Inspector General

OIG

http://oig.hhs.gov/

HMS

Medi-Cal Recovery Audit Contractor

http://www.medicaid-rac.com/medicaid-rac-activity/