Financial Section

The Financial Section is responsible for providing a variety of support services to all sections within MMAC. The Financial Section works with the Department of Social Services’ Division of Finance and Administrative Services (DFAS) and the state Budget Director regarding budgetary control, budget preparation, appropriations, revenue accounts and federal financial responsibilities to ensure compliance with the Missouri Medicaid Title XIX Program.

The Financial Section is responsible for the procurement of all required supplies, materials, equipment and professional or general services. The Financial Section has charge of the Health Management Systems (HMS) Third Party Liability (TPL) contractor audits, as well as the Recovery Audit Contractor (RAC) program and internal compliance with outside assessment review of the Missouri Medicaid Title XIX Program.

The State of Missouri has two annual reviews of the Title XIX Program, for which the Financial Services Section is responsible. This section is also tasked with auditing managed care organizations and other providers and developing Medicaid fraud and abuse standards for managed care organizations.

 

Health Management Systems (HMS) Audits

MO HealthNet (MHD) and Missouri Medicaid Audit & Compliance (MMAC) contract with Health Management Systems (HMS) to conduct: 

Long Term Care – Credit Balance Audits

Hospital – Credit Balance Audits (CBAs)

Commercial Insurance Disallowance Audits

 

Recovery Audit Contractor (RAC):

Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in the identification and recovery of improper payments, unless a waiver is obtained by the state.  This was based on the success of a pilot RAC Program for Medicare. The mission of this Program is to reduce improper payments in Medicaid through the efficient detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments.  Based on Missouri’s robust State Plan, CMS has granted Missouri a waiver to the RAC. 

For non-audit RAC comments/concerns, please direct comments or questions to email address dss.mmac.compliance@dss.mo.gov .