OMIG to Focus on ALP Billing and Documentation

OMIG has issued its 2013-14 workplan, which can be accessed here.  Below are the two categories of focus for Assisted Living Programs (ALPs), excerpted directly from the work plan:

Inappropriate Fee-for-Service Billings for Assisted Living Program Residents

Medicaid will not pay for any items furnished to an ALP when the cost of these items is included in the facility's rate. OMIG will identify goods and services delivered to ALP residents by other providers and billed to the Medicaid program but had also been included in the ALP payment rate, resulting in the Medicaid program having paid twice for these services.

Fee-for-Service Reviews of Assisted Living Program Resident Care

OMIG may conduct the above-mentioned reviews which are concerned with the documentation of care given to ALP residents. These reviews would focus on timely medical evaluations, interim assessments, plans of care, functional assessments, and the presence of relevant evidence of service provision.

LeadingAge New York recommends members share their OMIG audit experiences with us, as we worked to help improve the audit and related processes.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828