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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

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
slide15
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)
  • Audits Section - Sacramento
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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