powered by LeadingAge New York

OMIG Seeks Input on Draft LHCSA Private Duty Nursing Audit Protocols

The New York State Office of the Medicaid Inspector General (OMIG) is seeking input from Licensed Home Care Services Agencies (LHCSAs) on draft audit protocols for LHCSA private duty nursing. The protocols cover the following issues:

  • Missing or Insufficient Documentation of Hours Billed
  • Incorrect Procedure Code Billed
  • Missing Medical Orders/Plan of Care
  • Failed to Obtain Authorized Practitioner’s Signature Within Required Time Frame
  • Medical Orders/Plan of Care Not Signed by an Authorized Practitioner
  • Billed For Services In Excess Of Ordered Hours
  • Nurse Providing Service Was Not Licensed
  • Excluded Individual Providing Service
  • Billed for Services Performed by Another Provider/Entity
  • Patient Excess Income (“Spend-down”) not Applied Prior to Billing Medicaid
  • Failed to Maximize Third Party Benefit
  • Failure to Complete Annual Performance Evaluation
  • Missing Certificate of Immunization
  • Missing Documentation of a Tuberculosis Test or Follow-up
  • Failure to Complete Required Health Assessment

We encourage members to review the draft protocols and let us know if you have concerns or questions for OMIG by Fri., March 15th, so we can provide comment. Here are the current OMIG protocols for LHCSA private duty nursing to compare. The final deadline for comment is Wed., March 20th.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871