DOH/OMIG Meeting on CMI Audits

Nancy Leveille and Karen Morris Carl Pucci in Finance & Reimbursement

DOH and OMIG met with the associations Thursday, May 9, 2013 to provide their findings related to the phase one audits of the MDS data.

79 provider audits have been completed, including preliminary exit conferences, as well as optional second exit conferences via telephone.  The accumulated data is now being reviewed by OMIG for final accuracy, and will be sent to DOH rate-setting by the end of this month.  (OMIG noted that audits resulting in increased RUG scores would be documented for provider educational purposes only, and would not adjust the CMI upwards.)  DOH will then reach a decision-point on the release of the remaining $70M (which again, include increases both to the 79 audited facilities, as well as the remaining 171 facilities still subject to OMIG audit.)  DOH then estimates it will need 2 – 3 weeks in early June to process the rates, which then will be sent on to DOB and finally to EMEDNY for processing.  Best estimates as to actual payments to providers would be sometime during July, again subject to the above timetables being met.

As for the audit findings, see the attached document from the meeting.  They describe by category the findings.  One issue to note, after these initial audits, OMIG will drill deeper into the RUG categories for evidence of meeting the qualifiers.  Specific documentation, care planning and evaluation of goals needs to be a focus of the SNF staff with attention centered on easy ability for the auditor to assess.

Going forward, DOH may combine reviews of both the January 2012 and July 2012 census collections in an effort to get current and achieve a rolling six month audit cycle, which is their goal.  In addition, OMIG will consult with IPRO to potentially use their resources to assist in the ongoing audit requirements.

NYSHFA will continuously monitor this important issue and keep members informed on a regular basis.



Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36
  Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

Refer to #2013-259