Gather all financial reports and important documents related to Medicaid
Ensure all necessary patient data including demographics, diagnoses and treatment plans are compiled
Verify the billing codes and charges
Check the date and time stamp of each service offered
Inspect the service records to confirm provider signatures
Review the authorizations for any required services
Approval: Adequacy of Service Documentation
Check for discrepancies between services billed and services documented
Review the claims submission process and check for errors
Ensure compliance with Medicaid policies on patient's consent
Verify patient eligibility at the time of the services
Measure efficacy of current internal control systems
Prepare documentation for external and internal audits
Approval: Compliance Officer
Prepare responses to audit findings
Implementation of changes or corrections to the system based on audit findings
Monitor to ensure correction plan are effectively managed
Reporting on any identified issues and their resolutions
