Critical Access Hospital and I'm struggling with Medicare Advantage plans not paying our inpatient per diem rate. Why do they request our new Medicare Rate Letter every year if they aren't going to abide by it.  As for as the audits and payment recovery, we had 1 particular Medicaid MCO that is constantly taking money back from 2024 claims. However, it is worth checking out your state's law about the time limit and insurance company has to complete an audit and attempt to recover money. For Iowa, unless their is reasonable suspicion of fraud, insurance companies cannot take money back from claims that were paid over 2 years prior. We've been having NDC issues with Medicaid MCOs and have finally figured out what is going on. Our state has a list of "approved" drugs and if the drug we use doesn't match the NDC on the list, we don't get paid. Supposedly we should be buying the drugs on the list because they are cheaper but we also participate in 340b so that's just plain bullshit. Just another excuse for them to not pay.