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Promoting Interoperability Program Audits

Overview

The State of New Jersey will perform pre- and post-payment monitoring to ensure that incentive payments are paid in accordance with all Federal and State regulations and policies.

For more information on the 2017 and 2018 audit process click here.

Documentation

Original documentation to be tested will include, but not be limited to, the documents that support the patient encounter data and attestation data that support the adoption, implementation or upgrading to  Meaningful Use of certified EHR technology.

Providers should keep all documentation supporting attestation for 6 years in the event of an audit.

Prepayment and Post-Payment

Prior to issuing payment, all attestations will be reviewed based on information provided through the New Jersey Medicaid PI Program Attestation Application. These reviews will include electronic inquiries and manual reviews using available data sources such as the providers’ claims and encounter data stored in the New Jersey Medicaid Management Information System (MMIS) as well as other state databases and registries.

After the payment is issued, recipients will be selected for onsite inspection of the documentation supporting their original attestations and other eligibility criteria.

Representatives from the State contracted auditors, Mercadien P.C. Certified Public Accountants, will perform these onsite inspections and report any findings to the New Jersey Division of Medical Assistance and Health Services.

Appeals

As a provision of the law, States are required to establish a provider appeals process for eligibility, payments, and determinations of the PI Program. An appellant may appeal any Program action or decision related to the Medicaid PI Program, except those actions or decisions defined in federal or state law that are otherwise excluded from appeal.

The appeals process will allow providers 20 days from a formal notice of agency action to request a hearing on their complaint.  The hearings will be conducted by an Administrative Law Judge from the New Jersey Office of Administrative Law and conducted pursuant to this Office’s regulatory procedures with prompt, definitive, and final administrative action to be taken within 90 days from the hearing date. Providers will receive a written final decision from the Department and will have the right to pursue additional judicial review of this decision.

For more information on the appeal process click here.

New Jersey Innovation Institute
NJIT 400 Fenster Hall
323 Dr Martin Luther King Jr Blvd
Newark, NJ 07102

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mu@njii.com
973-642-4055, Option 2