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Provider Review Tips

May 31st, 2012

In-Home Services and Consumer-Directed Services revised 1/28/13 Follow the current care plan as closely as possible Never serve more than approved units Intermittent changes: If the services provided do not substantially match the care plan, document why and attach the … Continued

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Glossary of Definitions Used in the Medicaid Integrity Program

May 31st, 2012

ABUSE: Provider practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary, or that fail to meet professionally recognized … Continued

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