Health care providers are increasingly seeing request for records from all types of payors including but not limited Medicaid, Medicare and commercial insurance providers. The basis for receiving a requests for records could be as a result on any number of reasons, including compliance, aberrant billing practices or as a result of a ZPIC audit or general audit of claim subsmission.
Whatever the reason , responding to requests for records on a timely basis can help maintain the Provider’s cash flows or receivables, can help prevent claim denials, can help the provider avoid monetary sanctions from being imposed, and may help the provider from being placed on a payment suspension or from experiencing a deactivation of billing privileges. For example, Medicare contractors (First Coast Service Options, Palmetto GBA, Noridian etc.) can suspend or deactivate a provider’s payments for failure to timely provide records. In Florida, the Agency for Health Care Administration (AHCA) Medicaid Program Integrity unit (MPI) frequently imposes monetary sanctions, of at least $2,500.00, to its providers for failure to provide records, including business records, within the time frames provided and may also terminate the provider’s participation if no records are submitted.
If you are a provider who has received a request for records, kindly feel free to contact Mr. Ralph Gaitan, Esq., an experienced health care attorney at [email protected] or via (786) 440-8115 for further assistance or guidance in responding to requests for records.