MEDICAID COMPLIANCE AND DOCUMENTATION

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The New Jersey Department of Human Services changed the service delivery to Fee for Service under the Medicaid Community Care Waiver. The goal of this course is to review the new billing rules in Medicaid, how it impacts agencies, and provide an understanding of compliance standards. At the end of the training, trainees are expected to identify, monitor ongoing requirements and develop a systematic method to comply. As a result, trainees are expected to learn how to make changes in their operation, billing, auditing, fraud prevention, and setting staff expectations in regards to Medicaid compliance.

Please note that this workshop is sponsored 100% by the New Jersey Division of Mental Health and Addiction Services (DMHAS) and is FREE to its contracted/funded agencies. There is a nominal fee for agencies that are not contracted/funded agencies. Licensed but not contracted agencies are not considered free attendees.

No Show Policy: As with any event, there is a cost to providing FREE workshops to the community. DMHAS and the IT Project work with presenters to offer training that addresses current, relevant topics and depend on those who sign up to actually attend. Therefore, a $100 fee will be charged to those who do not cancel or give 24 hour notice that they will not be able to attend the event for which they have registered. SUBSTITUTIONS ARE PERMISSIBLE and preferred to cancellations. We prefer not to have to charge for no-shows so we hope you will attend the event offered

Topics may include but not limited to: Medicaid Overview, Defining Health Care Fraud, Waste, and Abuse; Clinical Documentation/Medical Record Documentation; Treatment Plan (Rehabilitation, Recovery Plan, Individual Service Plan, Care Plan); What is Billable or Not-Billable?; Audit Types; Ways to assure proper documentation; and plenty of examples, written work, interactive discussions and best practice sharing with peers.

Audience - Clinical Staff, Supervisors and Compliance Staff

Lead trainer Perry Iasiello MSW, LCSW who is an award winning executive with a track record of successful program leadership, providing consultation services, training and program implementation. He is concurrently the Executive Director Behavioral Health of East Orange General Hospital and President of Skyline Behavioral Health, LLC. In the past, Perry was the Executive Director Behavioral Health Services of St. Mary’s Hospital, COO of Allies, Inc., Director of Operations at Devereux, and Vice-President of Care Plus NJ. Perry has a Master Degree in Social Work from Fordham University.

Outline of Topics that may be included but not limited to:

• Medicaid overview – program, facts
• Why Compliance is Important
• Waivers 101, Requirements and Goals
• Compliance
  • Encounters Versus Claims
  • Certification Statements
  • Key Concepts of Risk Reduction
  • Defining Health Care Fraud, Waste, and Abuse
  • Clinical Documentation/Medical Record Documentation
    • Treatment Plan (Rehabilitation, Recovery Plan, Individual Service Plan, Care Plan)
      • Comprehensive Rehabilitation Needs Assessment
      • Progress Notes, Service Plan Reviews
• Medical Necessity
• The Golden Thread
• Community Support Services components, goals and rehabilitation
• What is Billable or Not-Billable?
• The Government Weapons
  • False Claims Act and Anti-Kickback Statute
  • Audit Types
    • Common Behavioral Health Medicaid audit findings
    • Recent NJ audit findings
    • Enforcement Actions
    • Creative ways to assure proper documentation
      • Examples, Exercises, and Written work