One of the main functions of the Arkansas Office of Medicaid Inspector General (OMIG) is to perform Medicaid provider audits.   The purpose of these audits is to determine the nature and extent of services billed to the Medicaid Program and to verify that Medicaid policies and procedures are being followed.  The following is a brief summary of the audits performed by OMIG and some guidance as to what providers may expect from an audit.

Field Audit:

• A field audit includes an on-site review and record request at the provider facility and/or provider’s office.
• No advance notice is required for an on-site review and record request per Arkansas Medicaid Policy §142.300.
• Every on-site visit will include both an entrance and exit conference.
• At the entrance conference a provider can expect to meet the review team performing the audit and discuss the needs of the review team related to the audit.
• The exit conference will be performed at the close of the on-site review, which may be after the review team has left the provider’s facility and/or office depending on the type of audit and medical records being reviewed.Within one hundred fifty (150) days of the close of field work, OMIG will issue a final audit report unless there is good cause to delay issuance of the report (See AR Code §20-77-1717).
• A provider has the right to request reconsideration and/or an appeal within thirty (30) calendar days of notice of the final audit report.
• A reconsideration report will be issued within sixty (60) days of the receipt of the request, unless good cause exists to delay the issuance of the report.
• Within ten (10) days of receipt of a reconsideration report that upholds all or part of a final audit report, the provider has the right to appeal.
• For more detailed information on the time frames and requirements for reconsideration and/or appeal, see the link below and Arkansas Medicaid Provider Manual §160.000.

Desk Audit:

• OMIG also performs desk audits.  These may include a mailed request for provider records.
• A mailed record request will include a timeframe for submitting these records to OMIG.
• A desk audit will not include an entrance or exit conference.
• The same timeframes and reconsideration/appeal process described above will apply to a desk audit.

This information is intended only to assist Medicaid providers in understanding the audit process and is subject to change.  No statutory or policy requirement(s) are in any way altered by any statement(s) contained herein. This information does not constitute rulemaking by the OMIG and may not be relied on to create a substantive or procedural right or benefit enforceable, at law or in equity, by any person. In the event of a conflict between statements in the information contained herein and either statutory or policy requirements, the requirements of the statutes and policy govern.  A Medicaid provider’s legal obligations are determined by the applicable federal and state law and Medicaid policy.

For more information on reconsideration and appeals, please click here.