Trip audit checklist: sample your own trips the way a broker or Medicaid auditor would

How to run the monthly trip audit

Once a month, pick billed trips at random, check each one against the same eleven points, and log what fails. The checklist below is the working form. Our guide to a NEMT quality assurance program shows what each check compares, what a red flag looks like, and how to size the sample, and the broker audit guide lists the records auditors ask for. Medicaid audits of NEMT providers shows what state and federal reviewers pull for a transportation claim.

1. Define the month’s trips. Use every leg billed or paid in the month, not the trips that were scheduled. That list is your population.
2. Draw the sample at random and record how you did it in Part A.
3. Pull the full file for each trip: the authorization, the trip record with times and signature, the GPS track, the driver and vehicle files for that date, and the claim with its payment.
4. Mark every check pass, fail, or not applicable in Part B.
5. Log each failure in Part C with its cause, its fix, and whether it changed what the payer owed.
6. Score the month in Part D, then sign it.

Whoever marks the checks should not be the person who billed the trips. The biller pulls files on request and nothing more. In a small office that usually means the compliance contact or the owner, and the guide to billing internal controls covers how to split those jobs among two or three people.

The checklist

Part A: The sample

Part B: Trip checks

Mark each box P (pass), F (fail), or NA. The codes:

Before the ride

• B1 Authorization. A trip or prior authorization number for this rider, date, and level of service, issued before the ride or under the payer’s after-hours rule.
• B2 Coverage. The rider was covered by this payer on the date of service.
• B3 Covered appointment. A medical appointment at one end, with the facility name and address recorded. For standing trips, the order or standing authorization is on file.

The ride

• R1 Times. Pickup and drop-off times on every leg, inside the payer’s window or with the reason noted, and possible for the distance driven.
• R2 Signature. The rider’s signature, or the substitute the payer accepts, with the reason written down.
• R3 Miles. Billed loaded miles within your tolerance of the GPS-recorded miles and a mapped direct route.
• R4 Vehicle and level. The van on the record is yours, passed its inspection that day, and matches the level of service billed.
• R5 Driver. License, required training, and broker approval current on that date, and the driver cleared on that month’s exclusion check.

The claim

• C1 Match. Rider ID, date, procedure code, modifiers, and units on the claim agree with the trip record.
• C2 Paid once. No duplicate payment, and no overlapping trip for the same driver or van.
• C3 Amount. The amount paid equals the rate for that code.

Before the ride

The ride

The claim

Part C: Findings log

Part D: The month in numbers

Picking trips at random

Let random numbers choose the trips, never a person. A sample picked by hand drifts toward the trips that are easy to find, and the hard-to-find trips are the ones an auditor will ask about.

1. Export the month’s billed legs and number them from 1 to the last one.
2. Generate random numbers in that range. OIG’s free RAT-STATS software is the main statistical tool of OIG’s own audit office and selects random samples; a spreadsheet’s random number function also works.
3. Write the source and the seed or starting number in Part A, so anyone can repeat the draw.
4. Keep simple random sampling as your default. OIG’s protocol for self-disclosed claims uses it unless there is a reason not to, and allows stratified samples when needed. A stratum per payer makes sense when a small payer would otherwise rarely come up.

Add targeted trips separately: a trip a rider complained about, a trip edited after the ride, or a new driver’s first week. Audit them with the same form, but keep them out of the error rates, because they were picked for a reason and would make the month look worse than it is.

Scoring the month

Report two numbers: the share of trips with any failure, and the share of dollars paid in error. The first shows how clean your paperwork is. The second shows how much money is at risk.

Count a trip whose record cannot be found as a failure for its full amount. OIG’s Self-Disclosure Protocol treats missing sample items as errors because program rules require keeping the support for every claim, so scoring a missing file as a pass would flatter the month.

An example with made-up figures: 25 sampled trips were paid a total of $1,150. Four failed.

• One return leg had no drop-off time. The payer’s rate did not depend on it, so it is a paperwork failure: $0 in error.
• One trip had no signature and no accepted substitute, under a payer that does not pay unsigned trips: $48 in error.
• One trip was billed as wheelchair, but the record shows a sedan was sent. The difference between the two rates was $34.
• One trip’s record could not be found: $55 in error.

The trip error rate is 4 of 25, or 16%. The dollar error rate is $137 of $1,150, or about 11.9%. These figures describe the sample only. Turning them into an estimate for the whole month takes a statistically valid sample and projection, which is part of scoping an overpayment, not of the monthly check.

When a finding is more than a fix

OIG’s guidance for small entities names three kinds of remediation an audit can lead to: repaying overpayments, changing processes, and educating staff. Most months need the second and third. When a failure changed what a payer owed, it is a possible overpayment, and the 60-day rule for Medicaid overpayments starts once you identify it.

• A pattern, not a slip. The same check failing for the same driver, dispatcher, or payer two months running points to a process problem. OIG’s guidance says audit results that suggest a systemic issue or improper conduct may call for an expanded audit or outside help.
• A broker finding. If a broker’s audit found the same problem, answer it with a written plan; the corrective action plan template has the format.
• A disclosure to OIG. OIG’s protocol requires a review of either every affected claim or a random sample of at least 100, and it does not let you subtract underpayments you found along the way. That is work for a health care attorney.

File each month’s checklist with the trip records it covers, so the next audit, internal or external, can see what you found and what you changed.

Running the audit from HealthRide records

HealthRide keeps the ride records that Part B checks against: GPS-recorded miles, the time of each pickup and drop-off, and signatures captured on screen. The trip log exports as a spreadsheet or a print-ready PDF from reports, which gives you the list of legs to draw the sample from. Each shift pairs a driver with a van, and credential expiry reminders and assignment guards help keep the driver and van checks passing before the audit ever looks.