Provider Update: June 8, 2016

​ADvantage and State Plan Personal Care FY17 Updated Audit Process

FY2017

(July 1, 2016- June 30, 2017)

Audit Tool

1. A copy of each audit tool that relates to the service(s) your agency provides is enclosed (ADvantage Case Management, ADvantage Home Care, &/or State Plan Personal Care). Specific questions about the Quality Assurance/Improvement Provider Audit tool(s) should be directed to the Oklahoma DHS/Aging Services (AS) Quality Assurance/Improvement Programs Assistant Administrator, Miranda Kieffer, at 405-522-0278 or email Miranda.Kieffer@okdhs.org.

Preparation for Audit

1. The Lead Auditor will contact your agency 10-14 calendar days prior to your audit to inform you of the audit date/time and the audit timeframe. If the person that is responsible for Quality Assurance at your agency will not be present during the audit, please provide the Lead Auditor with the name and contact information of the designee. 

2. At the conclusion of the Entrance Interview, the Lead Auditor will provide your agency with a list of Members and PCAs, if applicable, to be audited.  The Member Sample is a proportionate random sample.  Your agency will have one hour following the Entrance Interview to make available all requested Member Records and all requested PCA files to the audit staff; an additional 30 minutes may be given if the provider agency is required to pull PCA names for the sample Members.  The Lead Auditor will confirm that the requested Member Records/PCA files are present at the end of the allotted time, or sooner if the records/files are provided earlier.  Records/files not made available to the audit staff during the designated time will receive deficiencies for all conditions related to that Member Record or PCA file respectively. When your agency is notified of the upcoming audit, please inform the Lead Auditor or the QAI Programs Assistant Administrator if you have circumstances that would prevent you from complying with this process. 

3. The audit timeframe for ADvantage Home Care agencies will continue to be 12 months; however, the auditor will only review PCA files for PCAs that served members in the last 3 months of the audit timeframe. 

4. Additional information/documentation your agency may be requested to provide, includes:

• Policy/Procedure Book
• Incident Log
• Critical Incident Log
• High Risk Policy
• Sample Member Packet
• Sample PCA Orientation Packet

Member Contact

 

1. Members will be contacted to answer Member Perception conditions by telephone or by home visit.  The auditor will utilize information found in the agency file to determine the type of contact to be conducted. 

2. Member Perception conditions are not included in your agency audit score; however, Member responses will be recorded and provided on your audit reports.  

Annual Audit Exit Meeting

1. Exit Meetings are now conducted from the Lead Auditor's desk, utilizing SmarterMail.
   
    
2. After the Lead Auditor emails and reviews the Preliminary Audit Findings with you, your agency will be given two hours to review the document and determine if the auditor overlooked or misinterpreted information that was present in the Member Record or PCA file during the audit.
   
    
3. All relevant documentation you would like considered for refute needs to be emailed or faxed, utilizing the QAI SmarterMail directions provided by the Lead Auditor by the end of the allotted two hour timeframe.

Final Report

 

1. The Final Audit Report and recommendations will come from the Quality Assurance/Improvement Programs Assistant Administrator or designee via SmarterMail.

2. If it is determined that a Plan of Correction is needed, the electronic template will be sent with the final report via SmarterMail. 

3. Your agency will receive email notification once your Plan of Correction is approved. The Progress Report template, including the due dates of the required Progress Reports, will be attached to that email notification.

4. While MSU Provider Question (aau.providerquestion@aau.okdhs.org) is always used for specific Member-related questions, questions about the audit process or Final Audit Findings should be directed to the Oklahoma DHS/Aging Services Quality Assurance/Improvement Programs Assistant Administrator, Miranda Kieffer, at 405-522-0278 or emailqaiaudit@aau.okdhs.org and in the Subject line ATTN: Miranda Kieffer – QAI PAA.

State Plan Personal Care Audit (SPPC)

The SPPC Audit will be conducted at the same time as your ADvantage Home Care Audit.  When the auditor contacts your agency 10- 14 calendar days prior to your audit to inform you of the audit date/time and the audit timeframe, it will be inclusive of ADvantage Case Management, ADvantage Home Care and/or SPPC, unless otherwise noted on the call.  The SPPC Annual Audit Exit Meeting and the Final Report will be conducted the same as previously detailed in conjunction with the ADvantage audit(s).  Please remember that SPPC scores of 70% or less will result in removal from on-referral status the same as with ADvantage audits.

Follow-Up Audit

If your agency requires completion of a Plan of Correction for any Annual Audit, you will also be required to have a Follow-Up Audit.  The Follow-Up Audit will be conducted either on-site or off- site.  If conducted off-site, the Follow-Up Audit Nurse will conduct the audit from her desk, utilizing SmarterMail.  On-site reviews may be conducted if your agency's Plan of Correction contained a large number of deficiencies or if the agency score was below 70% on the annual audit.  The Follow-Up Audit Exit Meeting and the Final Report will be conducted the same as previously detailed.

Remediation Process

Following any audit, if your agency enters into the remediation process requiring a Plan of Correction (POC) and Progress Reports (PR), the QAI Programs Assistant Administrator or designee will send a one-time reminder via email 7-10 days prior to the due date of the POC or PR.  This email will be sent to the agency recipient listed on the Exit Meeting Sign-In sheet.

Beginning FY2017, Progress Reports are due no later than one week after completion of the 30-day self-monitoring period and will be accepted any time within that week.  They will not be accepted prior to the completion of 30 days of self-monitoring.  If the POC or PR is not received by the due date, your agency may be removed from the Certified Agency Report for a minimum of 90 days.

The POC and PRs must be submitted on the MSU POC/PR template provided by QAI for all audits.  Submission of a POC or PR on any other form will not be accepted and will be returned to your agency for completion prior to review. 

QAI Advisor

 The QAI Advisor will be utilized to complete 1:1 sessions with new provider agencies regarding the audit process and tools and with provider agencies that are removed from the Certified Agencies Report due to Annual Audit score of less than 70%.  The QAI Programs Assistant Administrator and Lead Auditors may also make referrals to the QAI Advisor for agencies requiring or requesting 1:1 assistance.

Financial Staffing Quality Review Audit (FSQR)

Beginning FY 2017, FSQR audits may be conducted randomly or on an as needed basis.

Other Information

Please be advised that the auditors have been instructed to maintain an established professional code of ethics at all times. 

• Auditors are instructed NOT to discuss the anticipated audit results with the Provider.  The Preliminary Audit Findings will be presented during the Exit Meeting.

• Auditors have been advised that during the Exit Meeting, they are to present the Preliminary Findings as determined by review of information provided by the Provider Agency (Member/PCA files and supporting documentation). Refute documentation will be accepted at the Exit Meeting; however, decisions regarding amendments to the final report will NOT be decided at the Exit Meeting.  Your agency will receive a final report that will indicate if an amendment was made.

• Auditors are expected to refrain from giving suggestions or recommendations to the Provider regarding processes to use with their staff to aid in complying with Program Standards, this information may be provided by the QAI Advisor.

• Any questions from the Provider regarding the formation of contractual documents or any concerns related to decisions and processes from AS Medicaid Services Unit (MSU) should be referred to Provider Question via SmarterMail.

• Any information or documents that the Provider needs to submit to the MSU-Tulsa office is to be forwarded by the Provider through the appropriate submission procedure, see provider update dated March 18^th, 2016.  These documents/submissions are not to be discussed, reviewed or accepted by the auditor(s).

We appreciate your cooperation.  We understand that your time is of value and, therefore, we strive to be of as little disruption to you and your staff as possible.

Recommendations provided by Provider staff are always evaluated for feasibility to assist us in providing quality outcomes for our members.

If you have any questions regarding the information provided above, please feel free to contact us via email at: aauproviderquestion@aau.okdhs.org.