Provider Self-Audit

The Department of Health Care Policy and 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.