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Are You Fully Prepared for a Medicaid Compliance Audit?

Assisted Living Programs and Skilled Nursing Facilities are among the fastest growing areas within the healthcare industry. Now more than ever, it is critical for Residential Health Care Facilities (RHCF) to strictly adhere to every compliance requirement in light of a substantial increase in regulatory oversight in recent years, say advisors at Demasco, Sena & Jahelka (DS&J) CPAs.

“The New York State Office of the Medicaid Inspector General (OMIG) reported that this year and in 2014, it is conducting more audits, investigations and data matches than ever before,” said Bob Jahelka. “Furthermore, if a provider fails to meet the necessary requirements of a Medicaid compliance program, it may be subject to stiff penalties, or in some cases, a revocation of its participation in the program.”

Here are some ways to enhance your own practices:

Maintain a Compliance Plan – It is important for an RHCF to construct a plan that serves as a foundation for the organization’s operations. This comprehensive plan should include key elements as identified by OMIG, such as written policies and procedures, a compliance officer and committee, and identification of compliance risk areas.

Importance of Documentation – Since resident records serve as the basis for payment, ensure that these documents are in good condition, well-organized, and include current data. In addition, make sure they are legible and complete.

Integrate Key Department Data – Ensure that a central body has complete oversight and tracks the essential information from each key department. For example, certain aspects of the Nursing and Admissions Departments should work in conjunction with the Billing Department.

Healthcare Partner – It takes a healthcare expert to set the right course for compliance.

DS&J can help you develop a focused scope of agreed upon procedures that will save you time and money while helping you navigate through the rapidly changing healthcare environment. Further details on these services can be accessed here: Assisted Living & Nursing Homes brochure.

For more information on the healthcare topic or another area of accounting, please contact Bob Jahelka at 516-861-3707 or or Victor C. Belgiorno at 516-861-3704 or .

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