Hospital – Credit Balance Audits

Multifaceted regulations and payers with different and sometimes competing requirements result in situations of inadvertent overpayment of claims. Identification and reconciliation of these overpayments must occur as quickly as possible to ensure payment integrity. MO HealthNet (MHD) and Missouri Medicaid Audit & Compliance (MMAC) contract with Health Management Systems (HMS) to perform Credit Balance Audits (CBAs) of hospitals.

HMS has created a provider-sensitive approach to work with providers to identify and reconcile any Medicaid overpayments. Once overpayments are identified and agreed upon, MMAC and HMS offer options for returning the overpayments to the State.

MMAC has approved a schedule for HMS to perform CBAs of hospitals. An audit may be conducted onsite by HMS representatives or be a simple desk audit where HMS requests and receives requested records. A CBA may occur more than once each year. HMS and MMAC strive to lessen the burden on hospital providers as much as possible.

For more information, please contact Dawn Pehle in MMAC’s Financial Unit, at 573-522-5633.