Frequently asked questions
Are these audits the same as the RAC audits?
No. MPRO is contracted independently and has no connection to the Medicaid RAC. Learn more about our audits.
Will these audits replace the RAC audits?
No. The HPPAC audits do not replace the RAC audits or any other audits that were previously performed.
What is the look back period for Hospital Post Payment Audit Contract (HPPAC) claim review?
Under this contract with Michigan Department of Community Health (MDCH), MPRO will not audit any claims whose date of service is beyond three (3) years, unless approved by the MDCH OHSIG.
What services will be reviewed?
This contract may review all inpatient or outpatient hospital services paid by Medicaid.
Will you be reviewing managed care claims?
Currently, we are only reviewing fee-for-service claims.
How do you determine which providers will be audited?
Data mining and analysis for upcoded or improperly paid Medicaid paid claims will be conducted. Then MPRO will determine if the determination of findings may be made via the automated process or if it requires medical record review and contact the providers. The selection of claims will not be random but instead based on what appears to be improperly paid claims and verified via the automated or medical records review process.
What is the maximum number of records that will be requested?
How frequent will the requests be? A: Record requests will be limited to 150 per request and no more than 500 within a 90 day period. This applies to all requests for records under the same billing NPI. The frequency of requests will vary and will depend on how frequent MDCH OIG approves scenarios.
How do I check to see the status of my audit?
Providers may contact Toria Spencer at 248-465-7368.
Providers may also register and logon to the MPRO Provider Specific Portal located under the View Secure Hospital Data link on the MPRO webpage at:
Will you communicate to providers if there are no findings?
Yes, providers will receive a letter if there are no findings for all record review audits conducted.
Who will the record requests come from?
For MPRO inpatient and outpatient post payment audits, all record requests and notification letters will come from MPRO.
What address will MPRO be sending record requests and notification letters to?
All initial mailings will go to the address listed in the CHAMPS Provider Correspondence Address. Mailings will be addressed to ‘Medical Records – Medicaid Liaison’ with a copy to the provider’s CEO. Initial letters will include detailed instructions on what records are being requested and the supporting documentation that should be provided. Please be sure that the department or staff persons obtaining mail from the correspondence address are aware of how to handle these record requests.
How do I submit record?
You can mail all requested documentation or send all CD/DVD copies to: MPRO Attn: HPPAC Address: 22670 Haggerty Road, Suite 100 Farmington Hills, MI 48335 Phone: 248-465-7300
Documentation submitted by secure fax should be faxed to: Fax: 248-465-7303
To send your documentation via the MPRO secure file exchange: Instructions found on the webpage at
Will there be an appeal process?
Yes. Please refer to the MI Administrative Code, Sections R400.3401 – R400.3424 for all MDCH appeal options: http://www7.dleg.state.mi.us/orr/Files/AdminCode/106_01_AdminCode.pdf
Who do we contact if we have more questions?
You may contact Toria Spencer at 248-465-7368 if you have further questions.
What is the time frame/deadline for submitting requested records?
All deadlines for submission will be provided in the records request letters sent to the providers. However, providers generally have 30 days from the date on the letter to respond to a request for records. To ensure there is no adverse action taken, providers may contact MPRO to request additional time prior to their submission deadline.
Will extrapolation method be used to identify overpayments?
While the extrapolation method may be used under the HPPAC audit contract, currently there are no plans to use extrapolation. If this changes, an announcement with details regarding the change will be provided.
When will HPPAC audits begin?
Medical Records requests are scheduled to begin January 2014.
If an inpatient admission is denied for inappropriate setting, will a hospital be able to bill outpatient claim? According to Medicaid Policy, Section 9.1 Prior Authorization Certification Evaluation Review (PACER), if an admission, readmission, transfer, or continued stay is not approved, MDCH does not reimburse for services rendered. Services during inpatient stays or parts of stays where that stay has been denied as inappropriate or unnecessary may not be resubmitted to MDCH as outpatient charges. Charges resubmitted as outpatient charges are monitored, and any payment made may be recovered during a post-payment audit.
How will the overpayments be recovered?
All providers are expected to electronically adjust their claims to correct their billing by adjustment or voiding the claim. These adjustments/voids will be offset by future payments just as any other claim corrected would be. Please be advised, if providers do not correct their claims, the claims will be submitted to MDCH for void of the entire claim. In the event the claim was to be adjusted, the providers would then be responsible to follow CHAMPS procedures for obtaining timely filing overrides to resubmit and receive payment for the correct version of the claim.