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State Medicaid "Look-Back Period"

  • 1.  State Medicaid "Look-Back Period"

    Posted 14 days ago

    What is your State Medicaid "look-back period" for Medicaid overpayments payments?

    Iowa's is 5 years and we are working to reduce this to 24 months https://www.legis.iowa.gov/docs/code/249A.42.pdf Iowa code refers to this as "overpayment" so don't get too hung up on the terminology. Iowa Medicaid continues to go back these 5 years and recoup (take back) funds from the Managed Care Organizations who turn around and withhold this amount from providers' current/future payments. In the end, providers are left with no means of recourse even though services were provided in good faith – eligibility was verified at the time, authorizations were received, services were provided, claims submitted & approved and the funder made payment to the provider AND then up to 5 years later, state can come back & go "oops" our mistake, we should not have paid you & now we're taking the money back.

    REFERENCES

    CMS Program Integrity Manual (pg 8) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mpi115c01.pdf

    • 7.4 – Look Back Period (Rev. 3, Issued: 02-02-2018, Effective 04-03-2018, Implementation: 04-03-2018) The UPIC shall defer to the state's look-back period for purposes of conducting an audit or investigation.
    • Unified Program Integrity Contractors (UPIC)

     Federal Regulations 42 CFR 433.316 https://www.law.cornell.edu/cfr/text/42/433.316



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    Flora A. Schmidt, Executive Director
    Iowa Behavioral Health Association
    2900 100th St, Ste 200 Urbandale IA 50322
    515/309-3315 office
    515/210-6212 mobile
    Flora@ibha.org
    www.ibha.org

    Advocacy & Knowledge Sharing for the Advancement of the Behavioral Health Field
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