Long Term Care – Credit Balance Audits
Inadvertent overpayments occur for a variety of reasons. MO HealthNet (MHD) and Missouri Medicaid Audit & Compliance (MMAC) contract with Health Management Systems (HMS) to conduct Credit Balance Audits (CBAs) at Long Term Care (LTC) facilities. The purpose of the audits is to identify and recover Medicaid overpayments resulting from situations including, but not limited to, payments made beyond the date of discharge, duplicate Medicaid payments, coordination with Medicare or other third party payments and patient liability application or collection errors.
HMS has created a provider-sensitive approach to work with nursing homes to identify and reconcile Medicaid overpayments. HMS has introduced a secure provider portal for transmitting documentation to and from HMS and responding to review results.
Any facility representative that would like access to their review through the HMS LTC Financial Review Provider Portal will need to register at https://ecenter.hmsy.com and click the link for new access. Once access is granted, you will be able to log into the Provider Portal using the above link. Your Review ID will also be required in order to utilize the provider portal. The Review ID can be found at the top of all letters you receive from HMS.
For more information, please contact Dawn Pehle in MMAC’s Financial Unit, at 573-522-5633.