Long Term Care
Overview of Audit Functions
The HP Long Term Care (LTC) Unit performs retrospective service
provision and case mix auditing functions on behalf of the Indiana
Health Coverage Programs. The HP LTC staff members conduct on-site
audits of IHCP-certified nursing facilities. Oversight is provided
for the Division of Aging, helping providers to achieve compliance
in documentation and billing, as well as helping ensure the health
and safety of the IHCP members.
Audit Frequency
The frequency of audits varies based on a provider's risk level.
HP Case Mix Audit frequency and provider risk categories effective
January 1, 2010 are as follows:
- A low-risk provider, defined as having a previous audit score
of 90-100 percent, will be audited at least once every three
years.
- A medium-risk provider, defined as having a previous audit
score of 80-89.9 percent, will be audited at least once every two
years.
- A high-risk provider, defined as having a previous audit score
of 79.9 percent or lower, will be audited every four to twelve
months.
The OMPP reserves the right to perform additional MDS audits as
deemed necessary at any time.
HELP DESK LOCATIONS FOR ADDITIONAL
SUPPORT:
HP LTC UNIT HELP DESK
Questions related to the Medicaid case-mix audits and Supportive
Documentation Guidelines.
Kimberly Honeycutt, R.N., QMRP, RAC-CT
(317) 488-5062
kimberly.honeycutt@hp.com
HP PROVIDER RELATIONS HELP
DESK
Questions related to LTC provider billing and claims.
(317) 488-5094
INDIANA STATE DEPARTMENT OF HEALTH (ISDH)
CLINICAL HELP DESK
Questions related to the clinical definition, intent,
completion, and/or interpretation of the Minimum Data Set (MDS) and
MDS Resident Assessment Instrument (RAI).
Barbara Wheeler, R.N.
(317) 233-4719
INDIANA STATE DEPARTMENT OF HEALTH (ISDH)
TECHNICAL HELP DESK
Questions related to all Centers for Medicare & Medicaid
Services (CMS) Reports including error messages, the Initial
Feedback Report and Final Validation Report, user IDs and Passwords
to CMS, and transmission difficulties to CMS.
Curtis Warfield or Dave Fowler
(317) 233-7206
MYERS and STAUFFER HELP DESK
Questions related to sequencing, error messages, assessment
corrections and Medicaid RUG-III value calculations associated with
all Office of Medicaid Policy and Planning (OMPP) reports.
(317) 816-4122