ISSUE
The Illinois Department of Human Services, Division of Developmental Disabilities (IDHS/DDD) seeks to ensure all billings for Consumer Day Services (CDS) are accurate, justified and are only provided by licensed providers.
BASIS FOR REVIEW
The IDHS/DDD must conduct ongoing annual reviews of Medicaid Waiver programs per the approved Medicaid Waiver Application.
METHOD OF REVIEW
The Bureau of Quality Management, Planning and Medicaid Administration within the Division of Developmental Disabilities will review billings for an individual who has greater than 8 hours billed on a single day between 7/1/17 and 12/30/17. This data is obtained from Mobius Report #M044K201 which reports on the first 2 quarters of the Fiscal Year. BQMPMA staff will notify those providers in writing requesting documentation to substantiate their billings.
FINDINGS
The review found 39% of the billings identified as greater than 8 hours were justified. The reasons identified for the unjustified billings were some CDS providers were not retaining acceptable attendance records, some billed for transportation and lunch which were not authorized in the Individual Service Plan, others identified systemic issues which affected billings and lastly some simply had data entry errors. Attached is a table breaking down the data gathered during this review.
ACTIONS TAKEN
Providers were asked to back out the erroneous billings, and monies that were paid out for those erroneous bills were recouped.
Total number of individuals with CDS billings during this timeframe:
145
Total number of providers found to have billings greater than 8 hours:
19
Total dates billed greater than 8 hours:
472
Of the 472 dates billed greater than 8 hours - 186 were justified billings and 286 were unjustified billings. Below is a breakdown of the unjustified billings.
| Unjustified Billings |
Number of Billings |
Total Providers Involved |
| Billed for Lunch/Travel |
102 |
5 |
| Billing Entry Error |
159 |
12 |
| Systemic Billing Issue |
25 |
4 |
| Corrected Billings |
286 |
19 |
Total money recouped from corrections: $9,820.54
