RCFs  and ALFs enrolled with Missouri Medicaid (MO HealthNet) may receive payments for personal care services provided in the facilities.  Missouri Medicaid Audit and Compliance (MMAC) may conduct an on-site audit or a desk review to determine whether the services were properly documented and billed, and that providers were paid appropriately.   An on-site audit means MMAC auditors will conduct an on-site visit, and scan the needed documentation.  A desk audit means MMAC will request records be sent by mail, fax, or email, without coming on-site.  To view the complete MMAC Provider On-Site and Desk Audits Guidance and Reference Material, click here.

 

For an RCF or ALF audit, MMAC auditors will generally ask to see the following documentation:

 

The care plan (Web Tool print-out or LTACS) for each participant, that corresponds with the review period EVV (Telephony) is not required for RCFs or ALFs Any and all documents that support services billed for each participant, for dates of service in the review period.  These may be timesheets, calendars, call-in logs, service delivery logs, or any other documents deemed necessary to complete the review.  MMAC auditors know that some providers use different names for documentation, and will communicate with you if they feel something is missing. A service delivery log must include the participant’s name, date of service (including the year), documentation of tasks performed, and appropriate daily signatures Census records.  If there are no census records, the auditors will request the medication administration records or nurse’s notes for the time period being reviewed Documentation of appropriate employee background (screening) checks, and documentation of a Good Cause Waiver if required A list of all employees who provided services during the review period (complete name, address, date of hire, date of first client contact, and termination date if applicable) Documentation of authorized nurse visits

 

MMAC auditors will use the following statute, regulations, and provider manual while reviewing the billing and the documentation for compliance:

 

RSMo 192.2495.2 13 CSR 70-3.030 13 CSR 70-91.010 19 CSR 30-86.042 19 CSR 30-82.060 MO HealthNet Provider Manual for Personal Care