Home Health Services
Myers and Stauffer has extensive experience assisting state Medicaid agencies with evaluating home health services and definitions; establishing home health agency reimbursement rates through gathering cost data, analysis, policy and system design; performing research; providing regulatory analysis and state plan support; and delivering provider training and assisting with other opportunities to engage stakeholders.
We provide the following services:
Audit and Attest
Bob Hicks, CPA
Home health services are key to allowing individuals to remain in their homes. As a result, state agencies continually review the program to ensure these services are accessible and effective. Our services include:
- Cost report collection.
- Web-based data exchanges for cost reports, supporting documentation, and related information.
- Cost report database management, analytics, and reporting systems.
- Audit and attest work programs and standardized work papers.
- Attest protocols compliant with state and federal definitions.
- Risk assessments to target audit work.
- Training programs for clients, providers, and other stakeholders.
Rate Setting and Reimbursement
|Amy Perry, CPA
As state agencies look to expand home health services, we serve as a partner to our clients to design, develop, and implement innovative and effective methods to meet state agency goals and objectives. Our rate setting services include:
- Home health reimbursement system design and implementation.
- Cost reporting tools development for state specific criteria.
- Cost identification of providing home health services by discipline.
- Home health rate calculations.
- Establish fee-schedule rates.
- Fiscal impact modeling.
- Cost settlement calculations and notice of program reimbursement.
- Program financing consulting.
- State plan amendment and administrative code consulting.
|Ryan Farrell, CFE
The aging population growth combined with an increasing number of seniors desiring to remain in their home will continue to stress the home health care industry. Through our benefit/program integrity services, we are able to assist our government health care clients with performing compliance reviews to determine whether the claims submitted for reimbursement are supported by adequate documentation (treatment plans, status reviews, service authorization records, time sheets, and other service notes, and any other applicable documents) and conform to any applicable criteria for reimbursement. We have extensive experience in identifying improper payments and identifying potential areas of fraud, waste, and abuse, including: medical necessity, services not rendered, services in excess of policy limits, duplicate services, unreasonable service duration, and qualified care givers. Our program integrity services include:
- Claims analysis.
- Post-pay claims audits – clinical and financial.
- Pre-pay claims audits – clinical and financial.
- Medicaid recovery audit contractor (RAC) services.
- Software modules for surveillance and utilization review subsystem (SURS), fraud and abuse detection services (FADS), and case tracking.
- Provider compliance.
- Payment system processing accuracy.
- Fraud, waste, and abuse detection (FWAD) litigation support.
Managed Care Oversight and Compliance
|Mike Johnson, CPA, CFE
The extensive services offered by our highly skilled managed care engagement team are generally focused on the oversight of health plans but can impact all provider types, including home health agencies. These services include:
- Encounter data reconciliation and validation.
- Financial audits, performance audits, and program effectiveness audits.
- Network adequacy assessments and member access compliance.
- Readiness reviews.
- Claims payment and denial assessments, accuracy, and timeliness.
- Medical record review.
- Grievance and appeals analysis.
- Contract compliance.
- Other provider-specific issue review and resolution activities.