b. Methods for Remediation/Fixing Individual Problems i. Describe the method for addressing individual problems as they are discovered. State’s Include information regarding responsible parties and GENERAL methods for problem correction. In addition, provide information on the methods used by the State to document these items. DDS is responsible for ensuring that provider billing is in accordance with the services authorized in the service plan. The Administrative Service Organization (ASO) will ensure that services are billed in accordance with the established rate for the service provided. If any discrepancy is noted the ASO will report the error to MassHealth and/or DDS and/or service provider and the services will only be claimed upon reconciliation of the discrepancy. Claims that cannot be reconciled with payment vouchers or other service documentation will be reported to DDS and will be denied. ii. Remediation Data Aggregation Remediation-related (check Frequency of data Responsible Party aggregation and Data Aggregation each that applies) analysis: and Analysis (check each that (including trend applies) identification) State Medicaid Agency Weekly Operating Agency Monthly Sub-State Entity Quarterly Other Annually Specify: Continuously and Ongoing Other Specify: Timelines c. When the State does not have all elements of the Quality Improvement Strategy in place, provide timelines to design methods for discovery and remediation related to the assurance of Financial Accountability that are currently non-operational. No Yes Please provide a detailed strategy for assuring Financial Accountability, the specific timeline for implementing identified strategies, and the parties responsible for its operation.
b. Methods for Remediation/Fixing Individual Problems i. Describe the State’s method for addressing individual problems as they are discovered. Include information regarding responsible parties and GENERAL methods for problem correction. In addition, provide information on the methods used by the State to document these items. DDS is responsible for ensuring that provider billing is in accordance with the services authorized in the service plan. The Administrative Service Organization (ASO) will ensure that services are billed in accordance with the established rate for the service provided. If any discrepancy is noted the ASO will report the error to MassHealth and/or DDS and/or service provider and the services will only be claimed upon reconciliation of the discrepancy. Claims that cannot be reconciled with payment vouchers or other service documentation will be reported to DDS and will be denied. ii. Remediation Data Aggregation Remediation-related Data Aggregation and Analysis (including trend identification) Responsible Party (check each that applies) Frequency of data aggregation and analysis: (check each that applies) State Medicaid Agency Weekly Operating Agency Monthly Sub-State Entity Quarterly Other Specify: Annually Continuously and Ongoing Other Specify: c. Timelines When the State does not have all elements of the Quality Improvement Strategy in place, provide timelines to design methods for discovery and remediation related to the assurance of Financial Accountability that are currently non-operational. No Yes Please provide a detailed strategy for assuring Financial Accountability, the specific timeline for implementing identified strategies, and the parties responsible for its operation.
ABI-RH%20Renewal%20Application-Clean%20draft-October%202017.docx