Long Term Care

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 (DA) and the Office of Medicaid Policy and Planning (OMPP), helping providers 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, follow:

  • 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 12 months.

The OMPP reserves the right to perform additional Minimum Data Set (MDS) audits as deemed necessary at any time.

HELP DESK LOCATIONS FOR ADDITIONAL SUPPORT

HP LTC UNIT HELP DESK

For 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

For questions related to LTC provider billing and claims: (317) 488-5094

INDIANA STATE DEPARTMENT OF HEALTH (ISDH) CLINICAL HELP DESK

For questions related to the clinical definition, intent, completion, or interpretation of the MDS and MDS Resident Assessment Instrument (RAI):

Barbara Wheeler, R.N.
(317) 233-4719

INDIANA STATE DEPARTMENT OF HEALTH (ISDH) TECHNICAL HELP DESK

For 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 for CMS, and difficulties with transmission to CMS:

Curtis Warfield or Dave Fowler
(317) 233-7206

MYERS AND STAUFFER HELP DESK

For questions related to sequencing, error messages, assessment corrections, and Medicaid Resource Utilization Group (RUG)-III value calculations associated with all Office of Medicaid Policy and Planning (OMPP) reports:

(317) 816-4122