Sneak Preview: Florida To Amend Medicaid Reimbursement Guidance

August 28, 2013 | By Jerry Ashworth | Post a Comment

xsass_bookshot(The following was excerpted from an article in the Single Audit Information Service). Florida health care agency officials planned to update written internal guidance to ensure agency analysts accurately calculate Medicaid reimbursement rates for the state’s health care facilities, addressing concerns raised in a Florida Office of Auditor General’s audit.

The Florida Agency for Health Care Administration manages the Medicaid program in the state. Medicaid reimbursement procedures are established in state law and define services provided by hospitals, nursing homes, intermediate care facilities for the developmentally disabled (ICFs-DD), rural health clinics and other facilities. ACHA collects annual cost reports from the facilities to calculate the applicable per diem reimbursement rate. ACHA also contracts with entities to audit the cost reports to determine whether it should adjust the amount paid as a result of a rate recalculation based on audited information.

To calculate reimbursement rates, AHCA developed cost reimbursement plans detailing the types of costs to be included in the calculation and the method to be used to calculate the rates. It also included instructions for calculating hospital and ICFs-DD reimbursement rates, which indicate what amounts should be included and where to find the amount in the facility cost reports. Using the facility cost reports, agency analysts prepare manual profile sheets, and data from these profile sheets is entered into the appropriate rate calculation system to identify the reimbursement per diem rate.

Three years ago, an OAG audit disclosed instances in which Medicaid reimbursement rates for hospitals and ICFs-DD were not calculated in accordance with written procedures, and that ACHA did not always ensure that a review of the manual profile sheets was documented by a second person. It recommended then that ACHA ensure the rates are calculated in accordance with established policy, enhance controls to ensure the calculations are performed correctly based on complete facility cost reports and ensure that all manual profile sheets are reviewed by a second person to verify reimbursement rates.


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