DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by:...
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Transcript of DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by:...
DEPARTMENT OF HEALTH CARE
SERVICES
Audits & Investigations – Financial Audits Branch
Presented by:
Gary Diffenderffer, CIAHealth Program Audit Manager
Introduction:
Financial Audits Branch (FAB) Cost Report Process:
Submission Acceptance Approval
Financial Audits Branch (FAB)
Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services
Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.
Cost Report Flow: Submission of Cost Report
Acceptance Acceptance Letter
Approval Approval Letter
Begin Invoicing TCM Program
TCM Cost Reports - Submission TCM Cost Reports due November 1st
Hard Copy Audit Review and Analysis Section
(ARAS)
Soft Copy [email protected]
(Audits Section – Sacramento)
TCM Cost Reports - Submission Hard Copy* – Includes, but not limited to the
following: Cover Letter Certification Statement Cost Report (Signed) / Including Funding Schedule Time Survey Template
List Worksheet Totals Worksheet Time Sheets
Cost Report Review Tool Supporting Documentation
*Refer to TCM Cost Report Instructions - 2009
TCM Cost Reports - Submission Soft Copy – Includes the following completed
items: Cost Report Template Survey Template
List WorksheetTotals WorksheetTime Sheets
Funding Schedule Cost Report Review Tool Template
TCM Cost Reports - Acceptance Acceptance Process :
Responsibility of ARAS:Completion of five page checklist:
Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report
Hard Copy Soft Copy
Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions
TCM Cost Reports - Acceptance Acceptance Process:
Contact designated LGA Coordinator for missing and/or incorrect items.
Via email:
Hello TCM Coordinator:
Please send the requested information via email within the next 24 hours.
Thanks,
ARAS
TCM Cost Reports - Acceptance Acceptance Process :
Acceptance Letter issued by ARAS
Acceptance Letter LGA
For each TCM Cost Report (LGA, CBO, and LPE)
Identifies “postmark date” to establish 36-month audit period
TCM Cost Reports - Acceptance Top reasons cost report was not accepted upon first
review:
1. Did not include “TCM encounters by month”2. IRS Form 990 not included3. Electronic copy of Worksheet A did not match
hard copy4. Complete Table of Contents not included5. Financial statements for CBO not included6. Electronic copy of Cost Report not submitted
TCM Cost Reports - Acceptance
Top reasons cost report was not accepted upon first review:
7. All pages of the Cost Report Review Tool not submitted
8. Hard copies not signed9. Incomplete CBO contract (need to include all
pages)10. Certification statements not signed11. Funding Scheduled not included
TCM Cost Reports - Approval Approval Process :
Responsibility of Audits Section - SacramentoReview of checklist completed by ARASIdentification of “potential” audit issues for
future auditsIssuance of Approval Letter
TCM Cost Reports - Approval Approval Process :
Approval Letter issued by Audits Section – Sacramento
Approval LetterOne letter issued for each target population
served by an LGAPurpose of the letter is to establish:
TCM Rate Period (2009/2010) Rate Per TCM Encounter TCM Maximum Amount
TCM Program Type (06): Public Health
Rate Per TCM
TCM Rate Period TCM Encounter Maximum Amount FY 2009-2010 $250.55 $100,220.00
TCM Cost Reports - Approval
Approval Process :
(Excerpt from an Approval Letter)
TCM Cost Reports - Approval Approval Process :
Approval Letter issued by Audits Section – Sacramento
LGA
Approval Letter
TCM
Program*
*The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount.
FAB Contact Information
Audit Review & Analysis Section (ARAS) Robert Kvick, Chief
(916) [email protected]
Audits Section - Sacramento Gary Diffenderffer, Supervisor
(916) [email protected]
DEPARTMENT OF HEALTH CARE
SERVICES
Audits & Investigations – Financial Audits Branch
Presented by:
Gary Diffenderffer, CIAHealth Program Audit Manager