Frequently Asked Questions / Link to OMIG Audit Protocols
This page previously contained a large list of general Medicaid related FAQs. Please note that those questions / the associated webpage is being updated as necessary to reflect the most recent regulations and Medicaid Policies. In the interim, please direct Medicaid questions to: OASAS General Counsel, Rob Kent at (518) 485-2312 or email@example.com.
OMIG Audit Protocols for Medicaid Reimbursed Services:
OASAS and OMIG have worked in collaborative regarding the development of audit tools that comport with OASAS regulations and associated Medicaid billing requirements.
OMIG Audit Page - Audit protocols assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law. The protocols listed are intended solely as guidance in this effort. The audit protocols do not encompass all the current requirements for payment of Medicaid claims for a particular category of service or provider type and therefore are not a substitute for a review of the statutory and regulatory law. A Medicaid provider's legal obligations are determined by the applicable federal and state statutory and regulatory law.
Below are links to the protocols for: OASAS certified Part 822; and, Part 818 programs. Additionally, please also see supporting information related to specific questions on the Part 822 and Part 818 Protocols.
- OMIG Part 822 Protocol - Note the Part 822 protocol does not apply for dates of service that pre date implementation of Ambulatory Patient Groups (APGs). The specific covered dates are listed on the OMIG Protocol tool.
- OMIG Part 818 Protocol - The specific covered dates are listed on the OMIG Protocol tool.
Part 822 Protocol: Supporting information for Part 822 Protocol Item 24 related to Group size:
Part 822 and Part 818 Protocol: Supporting information for Part 822 Protocol Items 20-23; and, Part 818 Protocol Items 13-16 related to Third Party Insurance coverage and/ or Medicare coverage:
- FAQ on program obligations regarding securing third party reimbursement and documenting denials of coverage or benefits.
- FAQ on non-hospital based OASAS certified Part 822 chemical dependence (CD) outpatient treatment program billing to Medicare for treatment services provided to a Medicare beneficiary by a CASAC (credentialed alcoholism and substance abuse counselor).
- FAQ on inability for a freestanding outpatient chemical dependence program to bill Medicare for treatment services because the delivered service was rendered by a practitioner type (e.g. a CASAC) that is not recognized or reimbursed by Medicare. In this instance, for those patients who have Medicaid coverage in addition to Medicare, may the program bill Medicaid instead?