How long does an audit or review take?
Draft Report/Preliminary Clinical Review Notice Timeline:
The average time from the onsite visit or formal request for records to issuance of the draft audit report or preliminary clinical review notice is three months
Informal Dispute Timeline:
If a provider disputes any draft or preliminary clinical review findings, they normally have thirty calendar days, although 60 days for some provider types, from the date the draft audit report or preliminary clinical review notice is received to notify the Division of Program Integrity of what they are disputing. § 1306.4 of Title 29 DCMR
Final Report/Clinical Overpayment Notice Timeline:
On average, the final audit report/clinical overpayment notice is issued within three months following the dispute process.
If a provider appeals the overpayment; they have 15 days from the receipt date of the final audit report or overpayment notice to request an adjudicative proceeding, also known as an “administrative hearing.” § 1307.8 of Title 29 DCMR