Why Home Healthcare Audit Will Be Important In 2023: Should We Review The Healthcare Provided In Homes?

January 5 , 2023

When your teacher announced a pop quiz, do you recall the sinking feeling you experienced?

Imagine that multiplied by a few billion to get an idea of how unsettling an audit template of a home healthcare agency might be. Fines, criminal charges, or expulsion from Medicare and Medicaid are much greater stakes.

The home healthcare system is designed with surveys and audits in place, so they can’t be wished away. The Community Health Care Services Foundation recently held a webinar titled “Home Care Audits – Facts & Trends” to help agencies get ready for the unavoidable.

(The CHC is HCP, the New York State Association of Health Care Providers educational’s affiliate.)

The major learnings from that session are listed below.

Higher Audit and Survey Rates

This will be a busy year for surveys and audits, said presenter Patricia Tulloch, a Senior Consultant at RBC Limited, Healthcare & Management Consultants.

Priorities for Surveys and Audits

The OIG’s suggestion is not random. The government wants state agencies to concentrate on certain sectors because of certain concerns;

• COVID19 scam

It was inevitable that dishonest people would abuse government money for COVID. Using COVID-19 as a launching pad for identity theft or invoicing Federal healthcare programmes for unneeded services are a few frequent types of fraud. Other examples include billing for phoney tests, immunisations, or treatments. The few dishonest service providers raise doubts about everyone. It is essential to maintain 100 percent accurate records in order to demonstrate the validity of each COVID19 service.

• COVID19 safety

It should come as no surprise that COVID19 safety is significant. Whether or not an agency agrees with the COVID politics or policies of the government, failing to do so could result in the loss of its licence. This area includes return-to-work regulations, COVID screenings, and immunisations, tracking, and training in infection management.

• Wage parity

New York State’s 20-21 State Budget tightened the screws on wage parity, and it meant business. Now that annual compliance statements are required to be submitted by June 1st, there is greater responsibility and control. Each episode of care, hour of pay parity care, and employee salary payment must be meticulously documented.

According to Each Audit, Expect the Following:

1. OMIG Audits Objective

By avoiding Medicaid fraud and recovering funds that were wrongly spent, OMIG audits help the state save money. Penalties are another source of income for them. OMIG seized $215 million through audits in 2020 alone!

OMIG audits will alert organisations to inconsistencies like these

• Missing or insufficient proof of billed hours
• Billed with the wrong procedure code
• Missing medical directives or a care plan
• Charging for services over the requested number of hours

The full list of LHCSA audit protocols is available for download on the OMIG website.

Audits for 2022 will also concentrate on

• Law requiring wage parity, as previously indicated
• Compliance with new EVV (Electronic Visit Verification) standards

Process

OMIG audits are comprehensive, protracted investigations. The auditors first schedule a conference call, then they choose and examine 100 clinical records from the previous three years. They’ll consider 2017–2019 in 2022. They also look at:

• Service records supporting billing (such as timesheets)
• Personal information

The auditors do an exit conference summary after they are finished. Your missing papers are listed in a Preliminary OMIG Report, along with a deadline for submitting them. They will then go over the data once again and create final real time reports.

As was already stated, the main goal of OMIG is to identify and reverse Medicaid overpayments. The auditors extrapolate their findings and multiply it by your total Medicaid billing if they discover an inaccuracy in the 100 records.

2. NYS DOH Surveys’ Objectives

The DOH is the government agency that grants licences to home healthcare organisations in New York. The DOH conducts periodic inspections after the first state licensure assessment to make sure the organisation complies with all applicable state and federal rules.

The DOH concentrates on your policies and practises, with a focus on COVID19 and infection control this year. In actuality, they’ll be examining your;

• COVID screening procedures (a selection from the last two weeks)
• List of personnel exempt due to illness
• PPE guidelines for infection control training
• Return-to-work regulations
• Support the replacement policy
• With a tonne more!

Process

For LHCSAs, DOH surveys are unannounced and take place around every three years. They did online surveys during COVID, but are now returning to in-person interactions.

When the surveyors arrive, they have already conducted extensive remote monitoring and have accessed your documents through data mining. They’ll compare that knowledge to the truth!

They’ll want substantial documentation in addition to the COVID policies already mentioned;

• HCR and CHRC procedures and policy
• Clinical data emergency disaster plan personnel files
• Plus more!

The Department provides you an Inspection report detailing any issues within two weeks of the survey. Following that, you have ten days to return with a documented, comprehensive remedial action plan. Following a review of the plan, the DOH makes a follow-up visit.

Conclusion

In the UK, numerous policies and instructions have been created. Despite this advice, some reports indicate that service customers’ experiences are still inconsistent. It’s possible that residents in nursing homes don’t always receive the best nutritional care, from the adoption of nutritional support pathways for those at risk of malnutrition to the provision of wholesome meals that residents like.

The necessity of care providers being able to analyse and, where required, improve the quality of nutritional care they are providing is highlighted by concerns about nutritional care and the growing amount of recommendations regarding nutritional care. This can be accomplished using a paradigm similar to clinical audit. If you are looking for professional report templates, get in touch with UrAudits, and get the best care home audit template in no time for digital audit solution.