OMIG Seeks LeadingAge NY’s Input on Draft CHHA EPS Audit Protocols
The Office of the Medicaid Inspector General (OMIG) is seeking input from Certified Home Health Agencies (CHHAs) on draft audit protocols for Episodic Payments. The protocols cover the following issues:
- Missing or Insufficient Documentation of Hours/Visits Reported
- Reported Services in Excess of Ordered Hours/Visits
- Billed Medicaid Before Services Were Authorized
- Plan of Care/Orders Not Signed by an Authorized Practitioner
- Comprehensive Assessment Not Documented/Late
- Missing Plan of Care/Order
- Supervision Visit Not Performed Within Required Time Frame
- Failed to Maximize Third Party/Medicare Benefit
- Billed for Services Performed by Another Provider/Entity
- Incorrect Rate Code Billed
- Ordering Practitioner Conflicts With Claim Practitioner
- Patient Excess Income (“spend-down”) Not Applied Prior to Billing Medicaid
- Failure to Use the Correct Discharge Code
- Failure to Use the Correct Revenue Code
- Failure to Conduct Required Criminal History Check
- Minimum Training Standards Not Met for the Home Health Aide
- Failure to Complete Required In-Service Training
- Missing Certificate of Immunization
- Failure to Complete Required Health Assessment
- Missing Documentation of a Tuberculosis Test or Follow-up
- Failure to Complete Annual Performance Evaluation
- Missing Personnel Record(s)
Please review the draft protocols and let us know if you have concerns or questions for OMIG. The deadline for comment is Sept. 19th. Current OMIG audit protocols can be reviewed here.
Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871