Exception Does Not Mean Deception!

I, like many other providers, recently received a letter from The Office of the NYS Medicaid Inspector General (OMIG) requesting records for home health visits billed to Medicaid for a specific day in January 2012. It seemed like a fairly simple request, or so I believed. I reached out to my subcontracting agencies and requested the needed records. I was absolutely 

mortified when I reviewed the exception visit information. The documentation was poor or non-existent. There was no process and positively no consistency in the way in which exceptions were verified. The Coordinators had a tendency of checking off "other" as the code for an exception, yet never documented a reason. They merely put a period or comment to bypass the HHA eXchange system. Most of my vendors were crunching to collect documentation, some even offering to update their notes to clarify how the exceptions were resolved. I advised against doing so, since it seemed impossible to provide authentic information three months after the exception visit had occurred. 

To summarize, the exception visits were managed so poorly across the board, that even I had my doubts - concluding that perhaps the exception visits were possibly "deception visits". After much reflection, I came to the realization that both providers and vendors lacked a full comprehension of the value and significance of a telephony system and the ramifications of its mismanagement. I think this was a learning curve for us all. I truly do not believe any deceptive activities occurred on the part of my vendors, but merely human slackness and carelessness. It is my hope that by sharing my story I can spare fellow providers and friends the mental anguish I endured throughout this experience.