Providers in Georgia just began receiving letters from the Georgia Department of Community Health (DCH), calling for providers to audit themselves for 2 years worth of records (7/1/2006 thru 6/30/2008), for Readmissions with Three Days of Discharge. DCH indicates, in the letter, that it’s Program Integrity Unit (PI) has already conducted a review of hospital admission claims, and found there to be potential billing errors submitted for reimbursement by hospitals.
Here are the salient points in the letter we wish to call to your attention:
- DCH indicates that this kind of UR review is demanded of them by Federal Regulations.
- Readmission within three days is the same admission, and cannot be billed. (There is an exception in the GA manual, however)
- Documentation must exist to justify Medical Necessity and appropriateness of setting.
- Lack of said sufficient documentation will result in recoupment.
- Self Disclosure is encouraged.
- Facilities who do not respond to this request will be audited by DCH-PI beginning May 1.
A letter we’ve seen is dated April 2, 2009, was received by a provider facility on April 7, so they have less than three weeks to review an unknown number of records, audit them, evaluate them, decide what and how to report them, then produce some kind of report to send to DCH, or DCH will visit the facility and do the audit themselves.
Downlaod a PDF of one of these letters from Georgia DCH HERE.
The letter does not state anything about what a “response” to DCH can entail, but we imagine that they might at least consider a “we’re working on it” letter as a satisfactory response, at least for a few weeks. Our own experience with Georgia DCH (and even the DOJ) indicates that they are reasonable and would probably be satisfied with this kind of a sincere response. You should make sure you do in fact give them a response in writing.
The letter does provide a name and number to call at DCH, should a provider have questions.
What Does This Mean?
It means, dear reader, buckle your seat belt.
You thought the RACs were bad news? These other agencies don’t have the limits that are being placed on the RACs, and the RACs will never show up at your door. They do mean business, because after all, these are tax-payer dollars being sent to you, and they are entrusted with safeguarding them.


