PURPOSE
The purpose of audits conducted by MAPS-MD is to examine the quality and appropriateness of medically necessary services delivered to consumers within the Public Mental Health System and to determine whether the services were billed accurately and supported through documentation in the medical record. Audits are critical in monitoring the accuracy of provider billings. However, they also play an important role in a program of continuous quality improvement.
TECHNICAL ASSISTANCE
In addition to identifying paybacks related to the inadequate documentation for billing services, MAPS-MD utilizes the onsite audits as a needs assessment tool to fully understand the strengths and weaknesses of Public Mental Health System Providers. Providers who are audited receive the following technical assistance:
- An extensive review of program strengths and weakness identified during the audit process during the exit conference.
- An Individual onsite audit report which review the findings of the audit, identify areas requiring a plan for improvement, and include a suggested plan for improvement regarding the agency's overall structure and program delivery.
- Ongoing Technical Assistance during the implementation of the improvement plan.
Audit findings are also aggregated to identify systemic provider needs. These findings are incorporated into the development of the Annual Training Plan for providers and the system of care as a whole.
POLICIES AND PROCEDURES
Mental Hygiene Administration (MHA), in conjunction with MAPS-MD and the Core Service Agencies (CSA's), has developed a policy governing provider audits conducted by any of these organizations. Please use the following link to the MHA Office of Managed Care Compliance Policy and Procedure.
• MHA Office of Managed Care Compliance Policy and Procedure for Provider Audits within the PMHS
AUDIT TOOLS
Mental Hygiene Administration has approved the following audit tools and definitions for scoring quality of documentation items. Depending upon the license of the program being audited, one of these tools will be used.
• Outpatient Mental Health Clinic (OMHC) Audit Tool, Definitions, Billing Review
• Individual and Group Practices Audit Tool, Definitions, Billing Review
• Psychiatric Rehabilitation Program (PRP) Audit Tool, Definitions, Billing Review
• Residential Treatment Center (RTC) Program Structure & Organization Audit Tool, Quality of Documentation Audit Tool, Definitions for Scoring Audit Items, Billing Review, RTC Seclusion and Restraint Definitions
• Inpatient Facilities Inpatient Billing Review, Inpatient Audit Definitions, Inpatient Audit Tool, Inpatient Audit Structure and Organization Definitions, Inpatient Audit Structure and Organization Tool
As additional tools are developed for other types of licensed programs, they will be added to this website.
RESOURCES
The following information will help providers meet licensing and Medical Assistance regulations:
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