Section: 4.03
Issued: 11.15.2011
Updated: 03.24.2023
Purpose
The purpose of this policy is to delineate the expectations around and procedure to complete voids at AHRC NYC.
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.
The designated person is responsible for routine voiding and adjusting of claims. When there are multiple claims to be voided or adjusted and the dollar amount is substantial, the designated person must report the issue to the vice president of Corporate Compliance prior to the void or adjustment. The vice president of Corporate Compliance documents the actions taken and determines whether a self-disclosure to the NYS Office of the Medicaid Inspector General (OMIG) in lieu of voids/adjustments is required.
Procedure
- The program department must complete the Agency’s void/adjustment form and provide any necessary supporting documentation to the Finance Department. Each program has a point person and a back-up person that is responsible to send the completed form and supporting documentation via email to the Finance Department, specifically the Revenue Cycle Coordinator & Director of Revenue Operations. Faxes, interoffice mail or drop offs are not permitted.
- Once the void or adjustment is received by the Finance Department and has been reviewed, the program department’s point person and back up receive an email from the Finance Department indicating a claim number for reference purposes.
- The void or adjustment is entered in a data base on a shared drive that is accessible by the program department’s point person and back up to show the status of the void or adjustment.
- When the void or adjustment is submitted to Medicaid or other payer, the program department’s point person and back up receive an automatic email indicating the date the void or adjustment was submitted to Medicaid or other payer. If the claim the program department is seeking to void or adjust, had not yet been submitted to Medicaid or other payer, the automatic email sent to the program department indicates “no bill sent.”
- If at any point in this process additional information is needed to process the void or adjustment, all communication from the Finance Department Revenue Cycle Coordinator & Director of Revenue Operations goes through the program department’s point person or back up.
Self-Disclosure to the New York State Office of the Medicaid Inspector General (OMIG)
When the designated person identifies to the vice president of Corporate Compliance inappropriate claims with a substantial dollar value, the vice president of Corporate Compliance, using OMIG guidelines, determines whether a self-disclosure to the OMIG rather than a void or adjustment of the paid claims is necessary. When it is determined that a self-disclosure to the OMIG is required, the vice president of Corporate Compliance follows all OMIG self-disclosure procedures and oversees repayment to Medicaid. Additionally, the vice president of Corporate Compliance notifies The Arc New York of the self-disclosure.