Compliance · Audits

How to prepare your financial records for a Medicaid (DHS) audit

Short answer

A Medicaid or DHS audit checks whether the services you billed were actually delivered and properly documented — and increasingly, whether your financial records back it up. The agencies that sail through are the ones whose books tie every dollar billed to a service record and a bank deposit, kept that way all year rather than reconstructed under a deadline.

What auditors look for

At its core, an audit tests one chain: billed service → documentation that it happened → payment received. If any link is missing or inconsistent, that’s a finding. Auditors increasingly cross-check billing against payroll, attendance, and financial records — not just clinical notes.

The records to have ready

  • A clean general ledger with revenue tied to billed services
  • Payroll by worker, with hours that tie to the services billed
  • Service logs / visit documentation supporting each billed unit
  • Bank statements and deposits reconciled to revenue
  • Provider agreements, authorizations, and retention-compliant records

The most common finding

It’s almost always the same: billing that can’t be tied back to documentation. The result is recoupment — repaying the disputed amounts, sometimes with interest, and a heavier review next time.

How to be permanently audit-ready

Don’t prepare for audits — operate audit-ready. Reconcile monthly, keep books service-linked, and retain documentation as you go. Then an audit is a request for records you already have, not a month of overtime.

Let NavSuccess handle itWe keep your books audit-ready year-round — every dollar billed tied to a service record and a deposit.

NavSuccess does this for home care & healthcare agencies — see Fractional CFO & advisory.

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Common questions

Who conducts these audits?

State Medicaid / DHS program-integrity units and their contractors; for Medicare, MACs and CMS contractors. All follow the same billed-to-documented-to-paid logic.

What is recoupment?

Paying back amounts billed that the auditor determines weren’t supported — the most common and most expensive audit outcome.

How far back can an audit go?

Look-back periods vary by program and state, which is exactly why consistent monthly records and proper retention matter.

Talk to an accountant who knows your agency

Book a free 30-minute consultation. We’ll look at where your books and compliance stand and show you exactly what we’d take off your plate.