The purpose of the Pre-Delegation Audit is to fully assess a proposed delegate’s capacity to manage and perform the delegated function in accordance with state and federal laws, rules, and regulations, accreditation organization standards and CarePlus requirements. The pre-delegation audit is conducted prior to the effective date of delegation. It consists of a desktop review of documentation, review of the proposed delegate’s provider downstream agreements and an on-site visit, if necessary. During the pre-delegation audit proposed delegates are notified of any reporting requirements and frequency, the process by which performance will be evaluated and the remedies available to CarePlus if obligations are not fulfilled. Pre-delegation audits are conducted by CarePlus in collaboration with our parent company, Humana, when applicable.
Collected information for the various delegated functions includes, but may not be limited, to the following:
** Policies and procedures
** Program descriptions and work plans
** Forms, tools, systems and reports
** Sub-delegation agreements
** Letters of Accreditation
** Financial Solvency
** File Audit
CarePlus requires all delegated providers to enter into a written, mutually agreed upon contract. The Delegation Services Addendum and applicable attachments at a minimum includes the following provisions: (i) delineates the duties and responsibilities of both the Plan and the delegated provider; (ii) outlines the services to be performed by the delegated provider, including reporting responsibilities; (iii) specifies that performance of the delegated provider is monitored on an ongoing basis by the Plan; (iv) retains the CarePlus’ right to approve, suspend and terminate individual practitioners, providers and sites where it has delegated decision making; (v) the credentials of medical professionals affiliated with the delegated provider will be either reviewed by CarePlus or the credentialing process will be reviewed and approved by CarePlus and will be subject to auditing on an ongoing basis; (vi) if CarePlus delegates selection of providers to the delegated provider, written arrangements must state CarePlus retains the right
to approve, suspend, or terminate any provider selected by the delegated providers; (vii) must comply with all applicable Medicare laws, regulations and CMS instructions; and (viii) provide for revocation of the delegation activities and/or other remedies in instances where the delegated provider is not performing satisfactorily. Grids within each delegation attachment are designed to delineate the actual functions and detail the requirements in each delegated arrangement, and may be tailored to define each agreement.
Medicare Payments, Reimbursement, Billing Guidelines, Fees Schedules , Eligibility, Deductibles, Allowable, Procedure Codes , Phone Number, Denial, Address, Medicare Appeal, EOB, ICD, Appeal.
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list

Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
CPT CODE and Description CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires thes...
-
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
URIBEL- methenamine, sodium phosphate, monobasic, monohydrate, phenyls alicylate, methylene blue, and hyoscyamine sulfate capsule Uribel i...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
-
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt...
-
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
-
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
-
FL 42 - Revenue Code Required. The provider enters the appropriate revenue codes from the following list to identify specific accommodation ...
-
LAPAROSCOPY ; LAPAROSCOPIC SURGERY Procedures and Related CPT and ICD-9 Procedure Codes CPT Code CPT Description ICD -9 ...

1 comment:
Amazing post. Keep it up. Much thanks to you such an incredible sum for sharing your beneficial blog. Internal Audit
Fixed Assets Audit
Post a Comment