Before we begin our discussion on Medicaid audits, let’s make sure that we know the core difference between Medicaid and Medicare.
Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income.
Medicaid is a state and federal program that provides health coverage if you have a very low income.
If you are eligible for both Medicare and Medicaid (dual eligible), you can have both. Medicare and Medicaid will work together to provide you with very good health coverage.
The underlying importance in understanding the difference between the two types of government assisted programs, will also help in understanding the scope of an audit and the policy reasons behind billing practices.
Medicaid is designed to help the poor. There is no questions about it. When a Medicaid patient visits their medical provider, proper documentation is needed at at each step – similar to any other patient, but in this case, the taxpayer is flipping the bill.
Documentation, documentation, and some more documentation:
That is the best way to sum up getting a “no-change” Medicaid audit.