Team Peak Performers: Home Health Administration- Equipment/Supply

This past February, Cook Children's Home Health was notified that the Office of Inspector General (OIG) would be conducting an audit of durable medical equipment (DME) Medicaid claims submitted by and to Home Health by Cook Children's Health Plan. This was the OIG's first audit where both a System owned health plan and a System owned home health DME Company were reviewed. The audit covered claims during the time period of September 2018 through August 2020.

The audit response team for this review involved Amanda Vespremi, Director of Reimbursement, Dorinda Dennis, Director of Medical Delivery & Supply Service, and Amy Peacock, Director of Patient Registration. These three individuals came together to work as a collaborative team for this endeavor. The review lasted from February 2021 to September 2021. During this time period Amanda, Dorinda, and Amy were involved in multiple face-to-face calls with the OIG team, which consisted of staff from various departments, and responded to numerous requests. As this was the first OIG audit of this kind, the HH team spent a great deal of time educating the OIG audit team on the forms and requirements of the state for the claims being audited as well as the processes for a home health DME company. The HH team worked together collaboratively to answer questions and gather data from multiple data systems to meet the audit requests, while still managing their normal duties. These three individuals displayed a positive attitude under pressure and showed what it means to pull together as a team. They were flexible, responsive, and were always attentive to the auditors' requests. Our HH team remained positive and provided support to their own staff despite the various interruptions to their day-to-day tasks. Without their collaborative and positive approach, this would have been a much more difficult audit.

Many articles you see regarding OIG audits result in large payments due to Medicaid, sometimes even into the millions of dollars. Despite the high stress created by this, the team presented themselves confidently and intelligently to the auditors. The OIG audit team was not only complimentary of the HH team on how organized, efficient, responsive, and helpful they were throughout the audit, but they also emphasized areas of strength for the departments they manage. This included how HH ensured selected DME and supplies claims were authorized by the HP unless the HP indicated prior authorization was not required. Documentation-supported members were seen by a physician within six months prior to the start of service. In addition, all claims tested were for members not residing in a hospital or a facility at the time of delivery. Through its Medicaid provider contract with the HP, HH received $13.6 million for DME and supplies delivered to 8,242 Medicaid beneficiaries during the audit period. Because of the efforts of the HH audit team and the leadership they display every day with their staff, the resulting repayment due to the state of Texas was only $3,429. Amanda, Dorinda and Amy exemplify how working together with a positive approach leads to a positive outcome. In our opinion, they exemplify what it means to be a Cook Children's Team Peak Performer.