Consultation Details

A typical audit includes a comprehensive review of a sample of your program's client files, personnel files, and applicable policy/procedure manuals. QAS generally spends three to four days on-site for each program that is selected for review. Consultation services provided by QAS have been detailed below, as many agencies prefer to tailor the audit to their individual needs. Please contact us to obtain additional information regarding our costs and fee schedule.

Client File Review - 2 Consultation Days Per Program

QAS conducts an in-depth review of ten (10) randomly selected client files to determine compliance with Medicaid behavioral health care policies and regulations. Treatment plans, client certifications, assessments, evaluations, progress notes and supporting documentation for Medicaid reimbursement services will be analyzed. The consultants are experienced at cross-referencing billable activities with supporting documentation in the client files to determine justification for Medicaid reimbursement. In order to determine compliance with documentation requirements for reimbursable services, the availability of the program(s) billing reports for the last three (3) months, including Medicaid remittance vouchers, billing logs, and/or service tickets is strongly recommended. The consultants will review the files to address identified deficiencies and will discuss this information with the Program Director and clinical staff throughout the mock audit.

Personnel File Review - .5 Consultation Days Per Program

QAS reviews five (5) personnel files including current, newly hired, and/or past employees providing Medicaid behavioral health care services. These files will be thoroughly reviewed to determine compliance with Medicaid policies and regulations. The consultants will identify deficiencies contained within the files and will discuss this information with the Human Resources staff throughout the mock audit.

Policy and Procedures Review - .5 Consultation Days Per Program

QAS reviews policy and procedures for programs receiving Medicaid reimbursement for behavioral health care services to determine compliance with Medicaid regulations. The consultants will meet with Quality Improvement staff and clinical staff throughout the review to discuss deficiencies that may be identified.

BHOS Program Review - 3 Consultation Days Per Program

In accordance with Medicaid's compliance reviews for Behavioral Health Overlay Services programs, QAS will conduct an audit of your agency's BHOS programs that includes the use of a specialized instrument, similar to the review tool used by the Agency for Health Care Administration. The BHOS program review includes an Administrative component (i.e. policy and procedure, personnel file review) and a Clinical component (client file review).

Training Sessions - .5 Consultation Days Per Program

Medicaid's most recent Handbooks require documentation of training in all clinical and case management personnel files. QAS offers an array of brief trainings, including the following:

· Evaluation and Assessment
· Treatment Planning and Review
· Community Mental Health Services Documentation
· Behavioral Health Overlay Services
· FARS and/or CFARS