Hello all:

 

Please disregard my previous email regarding ICF providers and DOM audit findings. I believe the below notice is preferable as it has a few more specifics. My apologies for subsequent emails.

 

Jeff

 

 

To All ICF Providers:

 

We understand that many ICF providers have recently received a Notice of Proposed Action and Proposed Adjudication Order from the Ohio Department of Medicaid (ODM) relative to potential Medicaid overpayments as a result of Medicaid audits for ICF services provided 7/1/2010 through 6/30/2011.   Some of these proposed overpayments are large sums.   Although the alleged audit findings appear to result from a variety of potential issues, one issue that is particularly troubling relates to denial codes that only apply to nursing facilities (NFs) and not ICFs.   OPRA is going to conduct some additional research around this issue and will work with ODODD and ODM to seek clarity about this issue, as well as other issues that arise as we learn more about the details of the potential audit findings.

 

In the meantime, however, it is important that providers preserve their rights and follow the instructions in the ODM letter regarding the appeal process.  Otherwise, at the expiration of the appeal timeframe, ODM will proceed and withhold the overpayment amount from future payments to you and you will have waived your rights.  According the letters that we believe ICF providers have received, providers are entitled to various due process including an audit conference with ODM and a subsequent Chapter 119 appeal.  In filing a request for the audit conference, providers have 30 days from the mailing of the ODM letter (not receipt) in which to request the audit conference.  Please double check the certified mail date on your letter (and envelope) to ensure that you timely file the request. In the request for the audit conference, providers must also fill out the form attached and list any issues to be contested.  At the audit conference, providers should be prepared to present specific reasons why the ODM audit finding is incorrect.   At the conclusion of the audit conference, providers will be given another notice of their Chapter 119 appeal rights if there are still issues in dispute.  Given the complexity of the issues and magnitude of the amount of the overpayments, providers may want to consult legal counsel, as well as their accountant. 

 

In the interim period, OPRA will be working with ODM and ODODD to better understand the specifics of the underlying proposed audit findings. We will provide the OPRA membership with further information as it becomes available. 

 

Thank you,

 

Jeff Davis

OPRA

 

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