Complete Story
02/29/2016
MUST READ! Update on ODM Post-Payment Claims Overpayment Review Reports
Update on ODM Post-Payment Claims Overpayment Review Reports
A number of LeadingAge Ohio members have shared that their “Post-Payment Claims Overpayment Review” reports from the Ohio Department of Medicaid (ODM) for fiscal year 2011 are substantially larger than in previous years.
In a call today with the staff of ODM, we learned that this year’s NF/ICF/IID audit reports for the first time have been prepared from MITS; previously the reports were created from MMIS. The issue, they say, is that the reports generated from MITS are pulling more detail than previously, and this detail is revealing that apparently thousands of LOC’s are missing that should have been reported previously. Nonetheless, ODM reports that EACH report was reviewed before being sent to the provider and, in fact, their reviews resulted in numerous corrections before the reports were sent.
LeadingAge Ohio strongly advocated on behalf of our members, along with other provider associations, and asked ODM to attempt to work out the level of care issues in MITS with the Area Agency on Aging and/or the County Departments of Job and Family services, but to no avail. Unfortunately this is going to require work on the part of providers to research the problems and provide the necessary documentation to ODM. However, the first and most important step is as follows: providers must submit a resolution request within the 30-day window. ODM said once providers submit their resolution request, they will work with the providers individually to correct the reported eligibility issues.
To save organizations time, ODM has offered two alternatives:
1) for organizations that have digitized records, ODM has indicated that they will send an encrypted email to which a provider can respond with the electronic info;
2) for those without digitized records, ODM is willing to go on site and spend time reviewing manual records.
ODM emphasized that they know that this process could be time consuming so are willing to work with providers to find an acceptable timeline for response. (Note: if the missing LOC is for a resident whose admission date was prior to 1997, no LOC is required; ODM has indicated they will let providers know what documentation is required in this circumstance.)
Again, the resolution request must be received within the 30-day window so the resolution process can be initiated. If questions, please contact Kathryn Brod at kbrod@leadingageohio.org, Nisha Hammel at nhammel@leadingageohio.org or Anne Shelley ashelley@leadingageohio.org.