The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Florida Medicaid Documentation Requirements
Records must be retained for a period of at least five (5) years from the date of service.
Types of Records That Must be Retained
Medicaid requires that the following types of records, as appropriate for the type of service provided, must be retained (the list is not all inclusive):
Requirements for Medical Records Medical records must state the necessity for and the extent of services provided. The following requirements may vary according to the service rendered:
Right to Review Records
Authorized state and federal agencies and their authorized representatives may audit or examine a provider’s or facility’s records. This examination includes all records that the agency finds necessary to determine whether Medicaid payment amounts were or are due. This requirement applies to the provider’s records and records for which the provider is the custodian. The provider must give authorized state and federal agencies, and their authorized representatives, access to all Medicaid patient records and to other information that cannot be separated from Medicaid-related records.
The provider must send, at his expense, legible copies of all Medicaid-related information to the authorized state and federal agencies and their authorized representatives upon request of AHCA. At the time of the request, all records must be provided regardless of the media format on which the original records are retained by the provider. All medical records must be reproduced onto paper copies unless otherwise authorized by the requestor.
Providers who are not in compliance with the Medicaid documentation and record retention policies described in this chapter may be subject to administrative sanctions and recoupment of Medicaid payments.
Medicaid payments for services that lack required documentation or appropriate signatures will be recouped.