CT’s Second Round of Medicaid Audits Leads to Revenue Recoupment, VIPs, and the Potential for Re-Auditing

Earlier this year, Connecticut providers reported the second round of annual case mix documentation audits from Myers & Stauffer had begun. With only a 10% threshold for non-compliance, it can be very difficult for providers to avoid monetary penalties. If Myers & Stauffer auditors find documentation does not support the MDS, the provider’s CT CMI average will be recalculated, and revenue already received will be recouped using the recalculated facility CMI average.  

Further, SNFs found to exceed the 10% threshold are required to develop and complete a Validation Improvement Plan (VIP). Recently Celtic learned, if a SNF does not complete and submit a VIP, the State of Connecticut will require the facility to be audited again within 180 days, which would include assessments from the same fiscal year.

Wondering if your documentation will pass audit standards? Celtic can help! We offer pre-auditing to identify areas of improvement and guidance for correction. We’ve been assisting CT providers to prepare for, and pass, their audits.

Have you been required to develop a VIP? Contact Celtic today, let’s discuss how we can assist you to create and carry-out an appropriate VIP.

About Lauren Videtto