Provider Self-Audit

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.