Contract and Fiscal Compliance Monitoring – Updated Negative Billing Procedures
The purpose of this information letter is to notify contracted providers of clarifications to the contract and fiscal compliance monitoring protocol in relation to negative billing.
In accordance with the current contract and fiscal compliance monitoring protocol, the current contract and fiscal compliance monitoring protocol allows the Department of Aging and Disability Services (DADS) contract staff to accept negative billing, when assessing billing compliance for the sample of individuals to be reviewed, if the negative billing is completed at least three workdays prior to the monitoring entrance conference.
Effective with the posting of this information letter, DADS contract staff will only accept a contractor’s negative billing, for the sample of individuals to be reviewed, when the negative billing has been successfully processed and finalized prior to receiving the sample for their upcoming monitoring visit, as reflected in either the Claim Activity section of the Texas Medicaid Healthcare Partnership (TMHP) Remittance and Status (R&S) Report or via a TMHP Claims Status Inquiry (CSI) which reflects the negative billing in a paid (“P”) status. DADS contract staff will not assess a recoupment amount when the negative billing has been successfully processed and finalized in this manner. Negative billings in pending status at the time of the monitoring entrance conference will not be considered by DADS contract staff when assessing compliance with billing standards and determining the amount of recoupment.
Please be advised that any resubmission of incorrect billing previously negatively billed successfully by the contractor and accepted by DADS contract staff to assess billing compliance may result in a fraud referral to the Texas Health and Human Services Commission – Office of Inspector General.
Visit us at Garlo Ward, PC