{"id":5475,"date":"2022-04-27T16:53:29","date_gmt":"2022-04-27T16:53:29","guid":{"rendered":"https:\/\/melodybenefits.com\/?p=5475"},"modified":"2023-08-24T14:35:12","modified_gmt":"2023-08-24T14:35:12","slug":"home_healthcare_audits_surveys","status":"publish","type":"post","link":"https:\/\/melodybenefits.com\/home_healthcare_audits_surveys\/","title":{"rendered":"2022 – Year of the Home Healthcare Audit?"},"content":{"rendered":"

Remember that sinking feeling you got when your teacher announced a pop quiz?<\/span><\/p>\n

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Now multiply that a few billion times to get the stomach-knotting sensation of a home healthcare agency<\/a> audit.\u00a0 The stakes are infinitely higher \u2014 fines, criminal penalties, or <\/span>termination from Medicare and Medicaid.\u00a0<\/span><\/p>\n

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Surveys and audits are built into the home healthcare system and can\u2019t be wished away.<\/span> To prepare agencies for the inevitable,<\/span> the <\/span>CHC<\/span><\/a> (Community Health Care Services Foundation) recently hosted a webinar called \u201cHome Care Audits – Facts & Trends.\u201d\u00a0<\/span><\/p>\n

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(The CHC is the educational affiliate of <\/span>HCP<\/span><\/a>, the New York State Association Of Health Care Providers.)\u00a0<\/span><\/p>\n

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The following are key takeaways from that session.<\/span><\/p>\n

Increased audits and surveys<\/b><\/h3>\n

Presenter Patricia Tulloch, a Senior Consultant at <\/span>RBC Limited, Healthcare & Management Consultants<\/span><\/a>, said it straight: \u201c<\/span>This will be a heavy year for surveys and audits.<\/b>\u201d<\/span><\/p>\n

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Why?<\/span><\/p>\n

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First, she pointed to the COVID staffing shortages that agencies are experiencing. With so many aides out, it\u2019s not always possible to replace them. Disgruntled patients or families, annoyed at not getting care, then file a complaint with the DOH. And complaints always trigger investigations.<\/span><\/p>\n

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The second reason traces Medicare and Medicaid oversight back to its roots in Washington. The <\/span>OIG<\/span><\/a> (Office of Inspector General) is a federal agency that fights Medicare and Medicaid fraud and abuse. It conducts studies and reports to Congress.\u00a0<\/span><\/p>\n

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In its latest work plan, OIG recommends increased auditing, investigations, and inspections of all healthcare providers. OIG doesn\u2019t perform audits, but its directive sets the agenda for the state agencies that do.<\/span><\/p>\n

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Audit and survey priorities<\/b><\/h3>\n

The OIG recommendation isn\u2019t arbitrary. The government has specific concerns, and it\u2019s directing state agencies to focus on those areas:<\/span><\/p>\n

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  1. COVID19 fraud<\/b> – It was inevitable that the unscrupulous would take advantage of\u00a0 government COVID funding. Some common examples of fraud include billing for fake tests, vaccines, or remedies, using COVID-19 as a hook for identity theft, or billing Federal healthcare programs for unnecessary services. <\/span>The few corrupt providers cast suspicion on everyone. It’s imperative to keep 1000% complete records to prove the legitimacy of your every COVID19 service.<\/li>\n
  2. COVID19 safety –<\/b> It\u2019s no surprise that this is also big. Whether or not an agency agrees with the government\u2019s COVID politics or policies, it risks losing its license by not following them. This category includes infection control training, COVID screens, vaccinations, tracking, medical exemptions, and return-to-work policies.<\/span><\/li>\n
  3. Wage parity – <\/b>New York State tightened the screws on wage parity in the <\/span>20-21 State Budget<\/span><\/a>, and it means business. <\/span>Annual Compliance Statements<\/span><\/a> are now due by June 1st each year, bringing a new level of accountability and oversight. Every <\/span>wage parity<\/span><\/a> hour of care, episode of care, and employee wage payment must be carefully documented.<\/span><\/li>\n<\/ol>\n

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    Getting into details, there are two routine investigations that New York HHAs face:<\/span><\/p>\n

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    1. NYS OMIG (<\/span>Office of the Medicaid Inspector General<\/span><\/a>) audits<\/span><\/li>\n
    2. NYS DOH (<\/span>Department of Health<\/span><\/a>) surveys<\/span><\/li>\n<\/ol>\n

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      Forewarned is always forearmed, so here\u2019s what to expect from each audit:<\/span><\/p>\n

      OMIG Audits\u00a0<\/b><\/h3>\n

      Purpose:<\/b>\u00a0<\/span><\/p>\n

      OMIG audits save the state money by preventing Medicaid fraud and recovering improperly spent funds. They also generate money from penalties. In 2020 alone, OMIG recovered $215 million from audits!<\/span><\/p>\n

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      OMIG audits will flag agencies for discrepancies such as<\/span><\/p>\n