BMS Billing Problems FAQ


FAQ
	1) Why was I chosen for review?
	2) I just received a letter informing me that OSU is coming for an on-site audit, what are my responsibilities?
	3) I received a draft report stating that I owe money for disallowed claims, what are my options?
	4) I received a final report from OSUR, and still think the disallowance is wrong, what are my options?


Solutions
top of page	1) Why was I chosen for review?
	A provider may be reviewed for multiple reasons. A Provider can be part of a group of providers governed by a specific Medical Manual or procedure code which is being reviewed. A Provider may be requested to provide records for review because a client receiving services at their facility is under review. A provider may be part of a referral made to OSUR for follow-up.
top of page	2) I just received a letter informing me that OSU is coming for an on-site audit, what are my responsibilities?
	All providers are required to maintain records of Medicaid services in accordance with guidelines in their respective manuals. At the time of review, OSUR would request a quiet place which has electricity for the team to work and access to a copier. During the entrance meeting, the team leader will ask the provider to define agency hours and other policy (i.e., security measures) that might effect team function. You will also be asked to designate a staff person with whom the team may work when questions arise while on site.
top of page	3) I received a draft report stating that I owe money for disallowed claims, what do I do?
	Draft reports are sent to the provider to explain the preliminary findings of the review team. The draft report contains client specific information which defines the issue(s) being reviewed, criteria being applied, services identified as disallowed, and explanations. The draft report allows the provider twenty (20) working days in which to respond and provide additional documentation or clarification they feel supports the appropriateness of the payment. Any additional documents or justification are reviewed prior to the issuance of a final report.
top of page	4) I received a final report from OSUR, and still think the disallowance is wrong, what are my options?
	If the provider disagrees with the final report, they may request an administrative hearing. All requests for administrative hearings must be in writing, addressed to the Commissioner of the Bureau for Medical Services, dated, signed and filed within 30 days of receipt of the final report. The request must contain a statement as to the specific findings in dispute and the basis for the provider’s contention that the findings were incorrect. The request must also identify the provider representatives who will be present at the hearing.

Office of Administration & Claims Processing / 350 Capitol Street Room 251 / Charleston, WV 25301-3709
Updated: 02/02/06
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