N.M. Admin. Code § 8.300.22.16 - AUDIT AND RECORD RETETION

Medicaid EHR incentive program participation and payments are subject to audit and recoupment if determined to be paid improperly. MAD will provide both prepayment verification and post payment audit of the payments made through the medicaid EHR incentive program.

A. MAD expects to verify most aspects of medicaid EHR incentive program eligibility as part of its pre-payment screening, including:

(1) active MAD provider participation agreement for an eligible professional provider and an eligible hospital or a MAD EHR incentive payment agreement;

(2) MAD eligible recipient volume for an eligible professional provider in an independent practice (broken out by FFS and for each contracted MCO);

(3) participation in the group practice identified by the eligible professional provider as meeting the threshold for MAD eligible recipient volume;

(4) total MAD eligible recipient for group practice;

(5) all members of a group use the same methodology for assigning eligible recipients to participating eligible professional providers;

(6) A/I/U certified EHR software for eligible professionals;

(7) not a hospital based provider for eligible professional providers;

(8) hospital eligible recipient volume from audit reports; and

(9) hospital incentive payment calculation (one-time process).

B. MAD may conduct post payment audits of any medicaid EHR incentive program participant. Post payment audits may include any aspect of medicaid EHR incentive program eligibility. An eligible professional provider, group or eligible hospital must maintain and make available documentation to support their participation in the medicaid EHR incentive program. Post payment audits will focus on verification of eligibility components not readily available to MAD as part of normal MAD program administration, including:

(1) validation of total eligible recipient volume, including "needy individuals" for all eligible professional providers;

(2) out-of-state medicaid eligible recipients;

(3) practices predominantly in a FQHC or RHC for eligible professional providers claiming that status; and

(4) meaningful use through meeting objectives for collecting and submitting clinical quality measures.

C. MAD eligible professional providers and eligible hospitals participating in the medicaid EHR incentive program must maintain all documentation supporting their participation in the program for six years from the date of receipt of any payment.

Notes

N.M. Admin. Code § 8.300.22.16

8.300.22.16 NMAC - N, 8-1-11