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Published byJustina Byrd Modified over 9 years ago
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What to Expect When Your System is Selected
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* Notification * Preparation * The Review * Preliminary Findings * Final Report * Follow Up
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* Date of review * List of children * List of documents that must be available * Information about family interviews * Notice sent * One week in advance for site visits * Two weeks in advance for desk audits
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* Local Site Visits * Desk Audits
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* Review Elements * Self-Assessment Tool * Communication with Local System Manager * Missing Information * Questions and Clarifications * Exit Interview
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* Written Report * Within 30 days of review * Includes * Purpose of review * Overview of strengths, required TA, need for IP * List of retractions * Opportunity to provide additional documentation * Opportunity to make billing adjustments
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* Sent via Certified Mail * 30 days after preliminary report, or * 30 days after receipt of additional information * Includes * Strengths, Required TA, Required IP * Family Interview Summary * Final Retraction List * Info that will be sent to DMAS Fiscal Unit * Appeal Process information (30 day timeline)
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* DMAS * DMAS Fiscal Unit – Follow Up on Retractions * Local System * Communicate Findings to LLA staff and contracted providers * Develop/Implement Improvement Plan * ITCVA Monitoring and TA staff work with LSM * Required TA * Oversight of Improvement Plan
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* For the Review itself * Site Visits * Desk Audits * For Positive Findings * Ongoing mechanisms for assuring qualified providers, adherence to requirements, quality services, effective processes, including documentation * Sample Tool * For Follow up
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* Family satisfaction; perception that services have made a difference in child’s development * Requirements usually met * Some great examples of coaching, communication and collaboration, and documentation
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* Documentation requirements * EI Processes and procedures * ASP, IFSPs, IFSP reviews * Determining outcomes/goals * Determining services – team process * Service delivery * Assuring qualified providers * Accurate billing
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* Missing/late Physician Certification * Practitioner not qualified * Incorrect codes * Billing more time than documented and/or than specified by IFSP * Billing date doesn’t match date of service * No evidence that parent was present
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