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Policy on External Audit Notifications <br /> I. INTRODUCTION <br /> NSMT has relationships with numerous payors who handle many claims for payment. Payors or their <br /> contractors will sometimes conduct Pre-Payment Reviews and Post-Payment Audits (collectively, "external <br /> audit notification") of NSMT's claims in order to verify the appropriateness of NSMT's billing. NSMT has <br /> adopted this Policy because it is extremely important for NSMT to respond to these audit notifications in a <br /> timely and organized manner. <br /> II. EXTERNAL AUDIT PROCESS <br /> A. NSMT employees must be able to differentiate between a pre-payment review and a post-payment audit <br /> notification/request for documentation letter. Generally, a pre-payment review is a payer's request for additional <br /> information prior to payment and is most often for one single claim or beneficiary. A post- payment audit <br /> involves the payer's review of specific claims to deter mine if these claims were billed appropriately. Both types <br /> of external requests will have an identified response due date and it is imperative that any response be <br /> coordinated through NSMT management and the Compliance Department to mitigate any potential legal <br /> liability for NSMT. <br /> B. Any NSMT employee who receives any external audit notification for documentation must be aware that it is <br /> a time-sensitive document. If you receive such correspondence, you must take the following steps immediately: <br /> 1. Date stamp the letter as "received"; <br /> 2. Send all requests for information to the Compliance Officer; <br /> 3. At the direction of the Compliance Officer will work with the Billing Contractor to collect all potentially <br /> relevant documents as requested by the payors. Documents should be organized according to the foiniat <br /> requested by the external agency and should be checked for accuracy; <br /> 4. The Compliance Officer will work with the Billing Contractor to appropriately log all relevant documents; <br /> 5. This log will track specific claim information as the documentation is being gathered in accordance with the <br /> request; <br /> C. The Compliance Officer shall work with the Billing Contractor to oversee the process of responding to an <br /> external audit notification. Never respond to, or contact, the Medicare Administrative Contractor(MAC) or <br /> Medicaid Fiscal Intermediary(FI)without the prior review and approval of NSMT Management and the <br /> Compliance Officer. <br /> D. The Compliance Officer will notify the requestor if an extension is needed. <br /> E. For Compliance and HIPAA security never provide documentation or correspond to an external request for <br /> information without first informing Compliance Officer. <br /> POLICY REVIEW <br /> The NSMT Compliance Officer will review and update this Policy and all Compliance policies when <br /> necessary in the normal course of its review of the NSMT Compliance Program. <br /> 57 <br />