PROGRAM INTEGRITY UPDATES October 28 & 29, 2020 PROGRAM - PowerPoint PPT Presentation

PROGRAM INTEGRITY UPDATES October 28 & 29, 2020

PROGRAM INTEGRITY

 AN ADJUSTMENT VERSUS AN APPEAL  POLICY CLARIFICATION OR QUESTIONS

FRAUD, WASTE & ABUSE

 The Fraud, Waste and Abuse (FWA) Administrator position has been filled.  We are happy to introduce Christina Altringer as the new FWA Administrator.  Providers should submit suspected fraud, waste or abuse on an SFN 20, Suspected Fraud Referral form. (REFER TO SLIDE 16 FOR REPORTING OPTIONS)

PROVIDER ENROLLMENT

 Revalidations on hold  Facility licenses  Negotiating with Noridian for enrollment work

SURVEILLANCE, UTILIZATION AND REVIEW SECTION (SURS) UPDATES

CURRENT AUDITS  telehealth  dental  Nursing Homes  Presumptive and definitive drug testing

FUTURE TOPICS  Ambulance  Covid Related  DME

PAYMENT ERROR RATE MEASUREMENT (PERM) UPDATES

Our next PERM cycle has begun Important submission dates 1. 12-01-2020 2. 01-15-2021 3. 04-15-2021 4. 07-15-2021

GENERAL PERM INFORMATION FOR PROVIDERS  NCI makes initial calls to providers to verify provider contact information.  NCI establishes a point of contact with providers and sends record requests  Providers have 75 5 days to submit documentation  NCI makes reminder calls and sends reminder letters on day 30, 45, and 60 until the medical records are received  If the provider does not respond, NCI sends a non-response letter on day 75 to the State PERM representative  If submitted documentation is incomplete, NCI requests additional documentation  The provider has 14 d 4 days s to submit additional documentation  A reminder call is made, and a letter is sent on day 7  If the provider does not respond, NCI sends a 15-day non-response letter.

HOW WE’D LIKE TO COMMUNICATE WITH YOU

We have a provider/stakeholder email list that people can sign up for at: http://www.nd.gov/dhs/services/medicalserv/medicaid/pro vider.html (very top of the page). Please encourage your partners and contacts to subscribe to our emails. We will send out updates, newsletters, etc. to this list.

PROGRAM INTEGRITY TEAM CONTACT INFORMATION Dawn Mock – Medicaid Program Integrity Administrator Phone: (701) 328 – 1895 Email: dmock@nd.gov Steven McNichols – Medicaid Audit Coordinator Phone: (701) 328 – 4831 Email: smcnichols@nd.gov Christina Altringer – Fraud Waste & Abuse Administrator/Managed Care Oversight Administrator Phone: (701) 328 – 4024 Email: caltringer@nd.gov

PROGRAM INTEGRITY CONTACT INFO - CONTINUED Gale Schuchard – Compliance Technician Phone: (701) 328 – 2334 Email: gjschuchard@nd.gov Missy Rosales – SURS Analyst Phone: (701) 328 – 3507 Email: melrosales@nd.gov Sarah Schaaf – FWA Analyst Phone: (701) 328 – 4682 Email: slschaaf@nd.gov

PROGRAM INTEGRITY CONTACT INFORMATION – FRAUD, WASTE AND ABUSE  General fraud email: medicaidfraud@nd.gov  Phone number: 1 – 701 – 328 – 4024 OR 1 - 800 - 755 – 2604 – select option 8 to speak with someone  Suspected fraud form submission link: https://apps.nd.gov/itd/recmgmt/rm/stFrm/eforms/Doc/sfn 00020.pdf

PROGRAM INTEGRITY CONTACT INFORMATION – PROVIDER ENROLLMENT General provider enrollment email: dhsenrollment@nd.gov Dawn Mock – Medicaid Program Integrity Administrator Phone: (701) 328 – 1895 Email: dmock@nd.gov

PROGRAM INTEGRITY CONTACT INFORMATION – PROVIDER AUDIT General audit email: auditresponse@nd.gov

FUTURE DATES  February 2021: the 24 th @ 2-3 pm and the 25 th @ 11-12 am  June 2021: the 23 rd @ 2-3 and the 24 th @ 8-9 am  October 2021: the 27 th @ 8-9 am and the 28 th @ 2-3

QUESTIONS

AS WE CLOSE…..  Questions  Comments  Ideas you have for potential future topics  Things you’d like to hear more about