November 15, 2023
IHA hosted a joint webinar with the Dept. of Healthcare and Family Services (HFS), the Department’s Office of the Inspector General (OIG), and the OIG’s Recovery Audit Contractor (RAC), HMS Gainwell, on Nov. 1, 2023.
To view a recording of this webinar, click here and enter the password AnMjs7yv. To view the slides from the webinar, click here.
The OIG’s RAC, HMS Gainwell, is restarting recovery audits on hospitals, beginning in November. These audits are a review of Medicaid payments with the goal to reduce improper Medicaid payments, provide education opportunities to improve accuracy of claims, and, if necessary, collect overpayments or identify underpayments. The webinar provides an overview of the clinical claim review process, medical records submission process and information on how to communicate with HMS Gainwell during the review process.
Frequently Asked Questions (FAQ) from the Webinar
Below is a list of FAQs from the webinar, with responses from HFS OIG and HMS Gainwell.
What steps should the provider take to ensure that their address and contact information is current?
HMS Gainwell obtains provider contact information for the initial audit notification letter from the Illinois Medical Program Advanced Cloud Technology (IMPACT) system.The “location” address listed by a provider in IMPACT is the initial contact address used by HMS Gainwell. The “location” address in IMPACT is the physical location of the business. Maintaining the correct information in IMPACT is the responsibility of the provider. A provider may update contact information in IMPACT by submitting a modification request in the IMPACT system. Presentations and Materials | HFS (illinois.gov) for more information on updating contact information.
Is a provider able to proactively verify contact information to be used by HMS Gainwell in the initial mailing prior to receiving a notice of audit?
The provider will not have access to the HMS Gainwell provider portal until an audit has been initiated. Thus, a provider cannot proactively register in the HMS Gainwell provider portal. However, the provider may contact HMS Gainwell Provider Services to inquire whether an audit has commenced and confirm the provider’s mailing address. Contact HMS Provider Services at (855) 699-6292 between 8:00 a.m.–6:30 p.m. CT.
The provider has confirmed HMS Gainwell selection for a RAC audit. May the provider register in the HMS Gainwell provider portal?
Yes, the provider can now register in the HMS Gainwell portal. Click here and follow the User Registration instructions. For portal technical assistance, you can contact HMS Gainwell at email@example.com or call 1-855-554-6748.
The location address may not be the best address for an audit notice because the compliance officer or records department is located at a different address. What steps can the provider take to include additional contact information for HMS Gainwell?
Once the provider registers in the HMS Gainwell portal, several options for providing additional contact information are available. The provider may add another address from the portal’s drop-down menu and designate that other address as “primary.” Changing the primary address in the HMS Gainwell provider portal will not modify the location address in IMPACT. A provider may also include other types of contact information in the HMS Gainwell provider portal, such as phone numbers and email addresses. Additionally, Provider Services can update contact information if you call 1-855-699-6292.
Once HMS Gainwell issues a notice of final audit finding and payment agreement to a provider, the Office of the Inspector General, Bureau of Medicaid Integrity receives information regarding the notice for tracking of payments and appeal requests. Who does the provider contact with questions regarding the payment agreement or appeal process?
The provider may send an email regarding payment agreements and/or appeal information to the Office of Inspector General RAC Coordinator at HFS.OIG.BMI.RAC@illinois.gov. This contact information is included in the final audit finding letter. Any correspondence to this email address must include the RAC claim number.
Questions on the audit process may be directed to HMS Gainwell at (855) 699-6292 or through their provider portal webpage.
Questions regarding this memo may be directed to IHA's Finance Contact Us form.