Traverse Bay Area Intermediate School District Medicaid School Based Services Billing Program Audit...
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Transcript of Traverse Bay Area Intermediate School District Medicaid School Based Services Billing Program Audit...
Traverse Bay Area Intermediate School
District
Medicaid School Based Services Billing Program Audit 2008-09
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Traverse Bay Area Intermediate School District volunteered for initial Medicaid audit review in the state
Michigan Department of Community Health was looking for an ISD that could provide an environment to fine tune the procedures that the newly hired auditor and his management team had developed. They needed to determine if their audit procedures were appropriate and sufficient for the School Based Services environment.
TBAISD was comfortable with the compliance procedures they had in place for the Medicaid School Based Services Billing Program, and felt an audit would be a learning experience.
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Audit Timetable TBAISD volunteered for audit October 1, 2009
The auditors scheduled three weeks of auditing time: October 12 through October 14, 2009 to review specific claims process, quarterly financial
reports and back up payroll reports October 26 through October 29, 2009 to follow up and visit selected LEA districts January 11 through January 14, 2010 to review new reconciliation process and revisit
selected LEA districts
The auditors requested: A workspace with a telephone Some tech support to make sure their computers could access their state programs All requested student records be printed and ready to go Access to Medicaid staff and appropriate business office personnel for financial questions Arrangements for visits to business managers at local districts
TBAISD informed all staff ahead of time that auditors would be in the building and to provide assistance if needed
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Student Records
Audit period: April 1, 2009 through June 30 2009
Auditors requested the following records for 22 students throughout the ISD, based on claims that had been received by State of Michigan Medicaid:
Printout of the billing documentation All student IEPs applicable to the time period Original special education referral Most recent evaluation documentation All required doctors’ orders/prescriptions All staff certification for those providing the billed services Electronic signature forms held on file for staff, representing staff claim
signatures Medicaid parent permission forms, not requested by auditors, but TBAISD
supplied
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Financial Reports The auditors:
Traced financial amounts reported on quarterly cost reports for the outreach program to payroll reports for both the ISD and LEAs
Reviewed the reconciliation process by examining MAER (Medicaid Allowable Expense Report) cost reports for both transportation and TBAISD direct services, and looked at the quarterly cost reporting for case managers for the ISD and LEA districts, and then traced those costs to payroll reporting
Searched for costs that had been reported to Medicaid, but funded by federal dollars, or inappropriate cost reporting for salary, benefits or “other costs.”
TBA did not bill for personal care services during this audit period
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Audit Findings
All TBAISD student records were complete in reference to the claims submitted
The auditors were pleased with the compliance procedures that TBA had in place, including:
Quality Assurance Committee (QAC) Meetings; our internal audits TBAISD Compliance Plan Procedures/plan in place to facilitate program compliance A comprehensive Medicaid team approach that involves both the
special education department and the business office operations
TBA has not received the official written report from the auditors
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Audit Findings Requiring Action
The auditors had concerns with the PCG Billing System in two areas: The billing program did not require comments for all services The billing screen did not show the Current Procedural Terminology (CPT) procedure codes, only a
description of the service type
Some TBAISD Outreach “non-salary costs” had been bundled on one line by department on the quarterly cost report
Auditors want to see these costs associated directly with corresponding staff members on the cost report list
The auditors want TBAISD to stay in the loop on all local district financial reporting “The final claim is owned by TBAISD”
Both TBAISD and its local districts had received federal dollars for salary and benefit costs that were then included on the cost reports for Medicaid
One local district included salary amounts on the quarterly cost reports for staff performing coaching/extracurricular activities
One local district had received federal dollars for transportation costs that were then reported for Medicaid reimbursement
TBA has not received the official written report from the auditors
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Audit Action List
Effective January 1,2010, all Medicaid services logged by TBAISD staff require comments describing the therapeutic procedure used and how the student responded
TBAISD worked with PCG to make sure that CPT (Current Procedural Terminology) procedure codes will now show next to billing service types on the billing screen
TBAISD made changes in business office reporting to protect against cost reporting errors
All local business managers were contacted to review issues with federal dollars and to confirm their 2008-09 cost reports for accuracy
Local business managers will now be required to copy TBAISD on the quarterly financial reports sent in to miaop (Michigan Administrative Outreach Program).
All 2008-2009 quarterly cost reporting corrections were made to Medicaid
TBAISD amended their previously completed 2008-09 reconciliation summary with the state
Deb Johnson, Medicaid Coordinator, TBAISD
February 2010
Future Plans for Program Implementation TBAISD will:
Continue a team approach that pulls together both special education and business office expertise
Stay in the loop throughout the year on all local district Medicaid financial reporting
Provide support to local districts with reminders when federal dollars are distributed
Share program updates with local business managers Amend their Compliance Plan and QAC Meetings to pull in new
internal audit procedures related to cost reporting and reconciliation
Continue to maintain high level billing screens for all program requirements, ex: scripts, IEPs, staff certification, current IEPs