Quality Assurance Solutions, Inc. - Medicaid Compliance Consultation Services

QUALITY ASSURANCE SOLUTIONS, INC.
Consultation Services

Overview of QAS Consultation Activities

Quality Assurance Solutions, Inc. consultants will conduct a friendly, internal mock audit that includes an entrance interview with the Program Directors, Lead Therapists, and key Quality Improvement staff to become oriented with your agency operations and Medicaid program(s). Additionally, an exit interview will also be facilitated by QAS to discuss the preliminary findings from the mock audit. The consultants will mail a solution-based written summary of the specific findings with recommendations for corrective action to the agency within ten (10) business days from the audit date. QAS is available to schedule follow-up visits to assist the agency with successful implementation of the recommendations. A written summary of each follow-up visit will also be provided to the agency within ten (10) business days of the visit.

QAS Specialty Areas

QAS specializes in Medicaid funded programs and services detailed in the Community Mental Health Services and Mental Health Targeted Case Management Coverage and Limitations Handbooks including:

Community Mental Health Services

Behavioral Health Overlay Services/Department of Juvenile Justice

(BHOS/DJJ)

Behavioral Health Overlay Services/Child Welfare (BHOS/CW)

Specialized Therapeutic Foster Care: Level 1, Level 2, and Crisis

Intervention

Mental Health Day Treatment

Rehabilitation Day Treatment, Basic Living Skills, and Social

Rehabilitation and Counseling

Intensive Therapeutic On-Site Services (ITOS)

Home and Community-Based Rehabilitative Services (HCBRS)

Therapeutic Programs: Individual and Group Therapy

Medical and Psychiatric Services: Psychiatric Evaluation, Clinic Visit,

Office and Outpatient Visit, Pharmacological Management Services

Assessment Services: Bio-Psychosocial Evaluation, In-Depth

Assessment, Limited Functional Assessment, Psychological Testing

Treatment Planning

Targeted Case Management Services

Children's Mental Health
Adult Mental Health
Intensive Team Adult Mental Health

A typical mock audit includes a comprehensive review of a sample of your program's client files, personnel files, and applicable policy/procedure manuals. Additional services available include the Identification of Lost Reimbursement Opportunities, Medicaid Financial Projections, Medicaid Provider Enrollment Activities, and Staff Training.

QAS Comprehensive Program Audit

Client File Review

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. A solution-based written summary will be provided detailing all findings with corresponding recommendations for corrective action.

Personnel File Review

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. A solution-based written summary will be provided detailing all findings with corresponding recommendations for corrective action.

Policy and Procedure Review

QAS reviews policy and procedures 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. A solution-based written summary will be provided detailing all findings with corresponding recommendations for corrective action.

Additional QAS Consultation Services

Identification of Lost Reimbursement Opportunities

During the client file review process, QAS will identify billable services that do not appear on the agency's reimbursement logs and will provide a summary of apparent non-reimbursed services that were rendered. Your agency may submit Medicaid reimbursable claims up to one year after the date that the service was rendered.

Medicaid Financial Projections

QAS will customize a user-friendly profile of your Medicaid program(s) that details the frequency of services that are currently being rendered, and a comparison profile detailing options for program development and expansion to increase the program's reimbursable service array (i.e. spreadsheets with units of service and corresponding Medicaid reimbursement broken down monthly and summarized in an annual projection).

Staff Training

Medicaid's most recent Handbooks require documentation of training in all clinical and case management personnel files. QAS offers a vast array of brief trainings, including but not limited to the following:

Medicaid Policy
Evaluations and Assessments
Treatment Planning
Documentation
Case Management
Service Plan Development
Utilization Management

Certificates will be provided by QAS for each staff member who participated in the training. The agency should maintain the certificates in each employee's personnel file to assure prospective auditors that staff received the appropriate trainings.