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DEPARTMENT OF HEALTH CARE SERVICES. Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager. Introduction:. Financial Audits Branch (FAB) Cost Report Process: Submission Acceptance Approval. Financial Audits Branch (FAB).

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DEPARTMENT OF HEALTH CARE SERVICES

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Department of health care services

DEPARTMENT OF HEALTH CARE SERVICES

Audits & Investigations –

Financial Audits Branch

Presented by:

Gary Diffenderffer, CIA

Health Program Audit Manager


Introduction

Introduction:

  • Financial Audits Branch (FAB)

  • Cost Report Process:

    • Submission

    • Acceptance

    • Approval


Financial audits branch fab

Financial Audits Branch (FAB)

  • Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services

  • Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.


Cost report flow

Cost Report Flow:

Submission of Cost Report

Acceptance Acceptance Letter

Approval Approval Letter

Begin Invoicing

TCM Program


Tcm cost reports submission

TCM Cost Reports - Submission

  • TCM Cost Reports due November 1st

    Hard Copy Audit Review and Analysis Section

    (ARAS)

    Soft Copy [email protected]

    (Audits Section – Sacramento)


Tcm cost reports submission1

TCM Cost Reports - Submission

  • Hard Copy* – Includes, but not limited to the following:

    • Cover Letter

    • Certification Statement

    • Cost Report (Signed) / Including Funding Schedule

    • Time Survey Template

      • List Worksheet

      • Totals Worksheet

      • Time Sheets

    • Cost Report Review Tool

    • Supporting Documentation

      *Refer to TCM Cost Report Instructions - 2009


Tcm cost reports submission2

TCM Cost Reports - Submission

  • Soft Copy – Includes the following completed items:

    • Cost Report Template

    • Survey Template

      • List Worksheet

      • Totals Worksheet

      • Time Sheets

    • Funding Schedule

    • Cost Report Review Tool Template


Tcm cost reports acceptance

TCM Cost Reports - Acceptance

  • Acceptance Process :

    • Responsibility of ARAS:

      • Completion of five page checklist:

        • Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report

          Hard Copy Soft Copy

        • Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions


Tcm cost reports acceptance1

TCM Cost Reports - Acceptance

  • Acceptance Process:

    • Contact designated LGA Coordinator for missing and/or incorrect items.

    • Via email:

      Hello TCM Coordinator:

      Please send the requested information

      via email within the next 24 hours.

      Thanks,

      ARAS


Tcm cost reports acceptance2

TCM Cost Reports - Acceptance

  • Acceptance Process :

    • Acceptance Letterissued by ARAS

      Acceptance LetterLGA

      • For each TCM Cost Report (LGA, CBO, and LPE)

      • Identifies “postmark date” to establish 36-month audit period


Tcm cost reports acceptance3

TCM Cost Reports - Acceptance

  • Top reasons cost report was not accepted upon first review:

    • Did not include “TCM encounters by month”

    • IRS Form 990 not included

    • Electronic copy of Worksheet A did not match hard copy

    • Complete Table of Contents not included

    • Financial statements for CBO not included

    • Electronic copy of Cost Report not submitted


Tcm cost reports acceptance4

TCM Cost Reports - Acceptance

  • Top reasons cost report was not accepted upon first review:

    • All pages of the Cost Report Review Tool not submitted

    • Hard copies not signed

    • Incomplete CBO contract (need to include all pages)

    • Certification statements not signed

    • Funding Scheduled not included


Tcm cost reports approval

TCM Cost Reports - Approval

  • Approval Process :

    • Responsibility of Audits Section - Sacramento

      • Review of checklist completed by ARAS

      • Identification of “potential” audit issues for future audits

      • Issuance of Approval Letter


Tcm cost reports approval1

TCM Cost Reports - Approval

  • Approval Process :

    • Approval Letter issued by Audits Section – Sacramento

    • Approval Letter

      • One letter issued for each target population served by an LGA

      • Purpose of the letter is to establish:

        • TCM Rate Period (2009/2010)

        • Rate Per TCM Encounter

        • TCM Maximum Amount


Department of health care services

TCM Cost Reports - Approval

Approval Process :

(Excerpt from an Approval Letter)

TCM Program Type (06): Public Health

Rate Per TCM TCM Rate Period TCM EncounterMaximum Amount

FY 2009-2010 $250.55 $100,220.00


Tcm cost reports approval2

TCM Cost Reports - Approval

  • Approval Process :

    • Approval Letter issued by Audits Section – Sacramento

      LGA

      Approval Letter

      TCM Program*

      *The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount.


Fab contact information

FAB Contact Information

  • Audit Review & Analysis Section (ARAS)

    • Robert Kvick, Chief

      • (916) 650-6673

      • [email protected]

  • Audits Section - Sacramento

    • Gary Diffenderffer, Supervisor

      • (916) 650-6963

      • [email protected]


Department of health care services1

DEPARTMENT OF HEALTH CARE SERVICES

Audits & Investigations –

Financial Audits Branch

Presented by:

Gary Diffenderffer, CIA

Health Program Audit Manager


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