The Department of Health Care Policy & Financing (Department) encourages providers to be active participants in ensuring the financial integrity of our healthcare programs. The Department strongly encourages all providers to routinely conduct internal self-audits and to disclose any overpayments of funds.
Examples of Improper Payments Suitable for Self-Audits include but are not limited to
- Services performed by an excluded individual or entity
- Billing errors
- System errors
- Up coding (billing with code where the payment amount is more than for the code which was used or was necessary)
- Unbundling bundled codes
- Unqualified person providing services
- Time based codes missing in and out or full amount of time spent on services in the record
- Signature and date missing on progress or services notes
If overpayments are identified during a self-audit, please follow the self-disclosure process to report the overpayments to the Department.