Policy Manual sample

MDT Home Health Care Agency, Inc. Utilization Review- Some of the Utilization Reviews will be conducted by an external accounting agency that is employed to assist our agency with financial compliance and Medicare reimbursement issues. Errors are defined as serious compliance problems or trends resulting in major billing adjustments to the Medicare/Medicaid bill. For example, nursing visits made to a patient with a non-draining wound without and skilled teaching completed would be adjusted off the Medicare bill. External Legal Audit- In order to assure compliance, MDT Home Health Care Agency, Inc. will retained the services of a law firm to provide external audits and external oversights regarding any activity that might be considered fraudulent if necessary. The law firm will be available to perform any external legal audit and has agreed to provide an objective examination of any problems and conduct its audit utilizing the protocol of the Office of Inspector General, U.S. Department of Justice, regarding false claims. The law firm will receive any record of a problem or situation and treat that report and the person making the report in a confidential manner. Additionally, a law firm will serve as a liaison to any investigation conducted by any governmental authority, including but not limited to the Office of Inspector General, U.S. Department of Justice and the Attorney General of the State of Florida. Home Health Agency Policies A-138