The Department of Medical Assistance Services (DMAS) Clarifies Credit Balance Audit Issues

VHCA members had voiced concern over the normal audit process administered on behalf of DMAS by Myers & Stauffer as it relates to credit balances caused primarily by patient pay, and other claims processing issues with the three Medicare/Medicaid Plans (MMPs) under the Commonwealth Coordinated Care (CCC) program.  Obviously, while the MMPs continue to sort out their processing issues, a recoupment by DMAS of credit balances would only serve to complicate the books further.

In response to the concerns, DMAS has clarified that they “are not interested in collecting credit balances potentially due the MMPs for the CCC program.  DMAS will accept reasonable documentation that the credit balance is a result of an overpayment from an MMP and will not include these amounts in recoupment.  DMAS reserves the right to review these credit balances in subsequent reviews.  This is not an open ended change to the process but only until the MMP payments are regularized.”

We will continue to monitor this situation, along with the MMP claims processing issues generally, as the program progresses.