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Non-Medicaid Reviews
 
 


ADAMHS staff will be conducting “on-site” reviews in accordance with Policy #306 Non-Medicaid Contract Services Year-End Reconciliation to verify services reimbursed by the for FY 2012. The review period is July 1, 2011 through June 30, 2012. The review will focus on the following services and activities:

 
 
  • Non-Medicaid services (AoD Residential, Housing, Employment, consultation, Prevention, etc.) provided to Medicaid and Non-Medicaid eligible individuals and

  • Medicaid eligible services (Behavioral Health Counseling, Case Management, CPST, Pharmacological Management, Medical Somatic, Assessment, etc.) provided to Non-Medicaid eligible individuals

  • Performance/quality improvement activities conducted during FY ’12. staff will conduct the “on-site” Non-Medicaid reviews during the months of July and August, 2013. Staff will use standard forms and checklists to verify the following:

  • Montgomery County residency

  • Documentation of billed service

  • Qualifications of provider

  • Medical Necessity of service

  • Non-treatment service is included in the agency’s FY 2012 Application for Funding

 
 

You may access the Policy #306 Non-Medicaid Contract Services Year-End Reconciliation

Please contact Su-Ann Newport (937) 443-0416, ext. 114 email: snewport@mcadamhs.org by June 10, 2013 to schedule your organization’s review.

Once your review is scheduled you will receive email confirmation of your review dates. If you have any questions regarding this correspondence or review, please contact Jewel Good at (937) 443-0416, ext. 131 or via email: jgood@mcadamhs.org.

We look forward to observing the work you do and appreciate your help in making this a smooth process for all.

 
   
 Tips for Non-Medicaid Review Preparation 
 


There are several items that agency staff have made available during non-Medicaid reviews in the past that have resulted in expediting the review, decreasing the time on site at the agency and improving the overall organization of the review. For your convenience we have listed ideas into the following tips:

 
 
  • Private room large enough to accommodate six to nine people

  • Provide a list of all clinical staff members (including terminated) who provided services during the fiscal year under review. Include the clinician’s degree, type of license (LPCC, LSW, etc.) and license number, expiration date of license, declared scope of practice and clinical supervision, when indicated

  • Identify if staff are Counselor Trainees and Interns. List Qualified Mental Health Providers (QMHP) and core competencies for position

  • Include staff identification number on staff list, if applicable

  • List of SAC codes or Crosswalk to identify the type of service on progress note, if HIPAA procedure codes and modifiers are not used

  • Approved list of agency’s abbreviations used in charting

  • Performance and/or Quality Improvement Plan in place during the fiscal year under review

  • Documentation of Performance and/or Quality Improvement activities that the agency engaged in during the fiscal year under review. Performance / Quality Improvement minutes, studies or other documented quality improvement processes

  • Access to staff by telephone extension or cellular telephone to provide clarification or answer questions

  • For agency’s that have electronic health records, access to computer stations or lap tops by staff that have security clearance to access protected health information. Staff available to provide just-in-time training on electronic health record to staff or that know how to navigate the electronic health record and can assist staff in their review

  • For agency’s that have hard copy documentation, post it notes on assessments, individual treatment plan and progress notes during the time frame under review are useful