Section: 4.03
Issued: 11.15.2011
Updated: 03.24.2023
Reviewed: 04.02.2024
Updated: 08.01.2024
Reviewed: 02.21.2025
Purpose
The purpose of this policy is to delineate the expectations around and procedure to complete voids at AHRC NYC.
AHRC NYC is required to adhere to all relevant Federal, State, and municipal laws and regulations, including but not limited to the NYS Social Services Law (SOS) §363-d, Title 18 of the New York Codes Rules and Regulations (18 NYCRR) Subpart 521-1, and the Deficit Reduction Act of 2005.
Overview
Each program department ensures that claims made to Medicaid have the appropriate documentation to support the claims. There are times when a program department or AHRC NYC Compliance Department identifies a claim or claims made to Medicaid that need to be voided because the documentation backing up the claim(s) is inadequate. This policy specifies the procedure that must be followed by the program department and by the Finance Department to ensure that a void is properly executed.
This policy also pertains to “adjustments.” Adjustments are made when the units billed do not agree with the program documentation. For example, when a full unit of day habilitation which requires four hours of service was billed, but the program documentation indicates only two hours of service. In this case a downward “adjustment” to the claim billed is required since the two hours of documented service time does not support a full unit.
Procedure
In such situations the Corporate Compliance Void/Adjustment Procedure, which can be located on the AHRC NYC portal under the Compliance tab, is to be followed.
The Corporate Compliance department will follow the OMIG Abbreviated or Full Disclosure process as indicated by the circumstances.