OMIG Audits: Have No Fear, AWARDS is Here!

The phrase “OMIG Audit” strikes fear in many agencies. If you bill for Medicaid in New York, you never know if or when the Office of the Medicaid Inspector General (OMIG) might come audit your files. We often get questions from both current clients and prospects about how AWARDS users fare in OMIG audits. The answer is – that depends on how well you use AWARDS. You’ve heard the old saying – “Garbage In, Garbage Out.” But the good news is, if you use AWARDS well and implement some internal data quality processes – you can successfully breeze through an OMIG audit with ease!

Options for Community Living, Inc., a nonprofit agency on Long Island, has been providing housing, support services, and coordinated care for people recovering from mental illness and those living with HIV/AIDS or other chronic health conditions since 1982. They have been AWARDS users since late 2010 and have developed a variety of data quality review processes to ensure the agency’s AWARDS data is robust and accurate. In the summer of 2014, OMIG notified Options that they would be audited for more than 100 Medicaid claims paid to them for their OMH rehabilitation services during the period of 1/1/09 – 12/31/11.

This was the agency’s first OMIG audit so staff immediately got to work and set up a committee made up of of Executive, QI and Program staff. The committee was charged with reviewing the records of 269 residents who resided in their programs during the audit period. The audit period was split – about half with their old record system and half with AWARDS. After a full day of staff members reviewing various chart records, they determined that their data quality procedures resulted in records which were accurate and complete.

The OMIG auditor arrived in July of 2014 and went through records for the next four months. Options prints out many of the agency’s AWARDS records to keep hard copy binders for all residents. While their internal reviews and quality improvements procedures use AWARDS for review, the OMIG auditor opted to review the paper charts – reviewing a sample of 100 Medicaid claims. After several months of waiting to hear the results, they received a letter in March 2015 from OMIG stating that the audit revealed they had “adhered to applicable Medicaid billing rules and regulation” and that “no further action is warranted.” And just like that the agency was able to confirm that its AWARDS record keeping practices align with OMIG requirements.