Association Executive Directors Community

 View Only

State Medicaid "Look-Back Period"

  • 1.  State Medicaid "Look-Back Period"

    Posted 01-07-2022 16:03

    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 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.


    CMS Program Integrity Manual (pg 8)

    • 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

    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

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