Guidelines for Medicaid recovery audits advanced

Senators advanced a bill from general file May 20 that would set guidelines for Medicaid recovery audits in Nebraska.

Omaha Sen. Sara Howard, sponsor of LB315, said the bill was introduced following complaints from dentists regarding onerous audit requirements. The Affordable Care Act requires Medicaid audits by a Recovery Audit Contractor (RAC), she said.

“Some providers testified that if this process was not changed, they’d be forced to give up providing services to Medicaid patients,” Howard said.

A Health and Human Services Committee amendment, adopted 30-0, replaced the bill. Lincoln Sen. Kathy Campbell, chairperson of the committee, said the amendment reflects changes and clarifications resulting from a compromise between the state Department of Health and Human Services (DHHS) and the Nebraska Dental Association.

Among other provisions, the amended bill would:
• clarify that only one audit may be conducted at a time;
• exclude from review claims otherwise audited;
• require claim review within two years of the date of payment;
• align the appeals process with DHHS practice;
• require procedures for re-billing corrected claims; and
• require audit completion within 60 days of receipt of all requested material.

Seward Sen. Mark Kolterman supported the bill and the amendment. The state needs to perform audits, he said, but the current RAC audit process has been unreasonably implemented.

“We’re losing dentists that want to take care of Medicaid patients simply because they don’t want to go through this nonsense,” Kolterman said.

Following adoption a technical amendment offered by Howard on a 28-0 vote, senators advanced LB315 to select file 29-0.