Effective January 1, 2015, the MSU-Quality Assurance/Improvement (QAI) department will begin completing Financial/Staffing Quality Review (FSQR) pilots, in accordance with the current ADvantage waiver and performance tracking requirements of Centers for Medicare and Medicaid Services (CMS). This means all Home Care and Case Management Provider agencies will have a financial audit to ensure the integrity of provider billings for Medicaid payment of ADvantage waiver services.
The FSQR will address provider claims to include (1) claims payment with corresponding documentation of service delivery and (2) claims payment within limits of service plan authorization as reflected on the 6g.This information will be reflected in one report with two sections that delineate (1) the number of incidences per Member and (2) the number of incidences per service type for all Members reviewed.
Due to the accelerated implementation of this requirement, we are scheduling Financial/Staffing QAI advisements specifically regarding the FSQR tool and process, upon request by provider agencies during the dates of November 5, 2014 through December 15, 2014. These requests should be sent to firstname.lastname@example.org.
A SmarterMail account has been set up for provider audits which includes an email and fax number for all documents to be sent to MSU-QAI. Effective immediately, the Document Submission QAI Audit (form 02CB301E) will be utilized to facilitate QAI data collection reporting of ADvantage Member personal health information for provider audits.
Upon request of any documentation from the QAI department which contains personal health information, the form will be completed by the reporting agency, submitted to QAI via email at email@example.com or fax to 405-230-8026, which is also listed on the cover sheet.
SmarterMail email is the preferred method of sending documentation. If email is used, you must include in the subject line all of the following information: Lead Auditor Name (Last Name, First Name), Agency Name, Branch Name (if applicable), Program (ADvantage or SPPC), Service (CM or HC), and Audit Type (Annual or Follow Up). The Audit Document Submission form is not available on the website at this time; however, it can be provided through Provider Question. Please adhere to the recommended guidelines.
If you have any questions regarding the information provided above, please feel free to contact us via SmarterMail at: firstname.lastname@example.org.