For providers under the New York Medicaid program, they must consider their compliance program’s risk assessment activity and how the many various service reimbursement models may impact required risk assessment factors, clinical and administrative processes, and clinical and billing outcomes.
The following are all identified factors to monitor and ensure compliance to requirements under 18 NYCRR § 521.3:
- medical necessity and quality of care;
- mandatory reporting;
- credentialing; and
- other risk areas that are or should with due diligence be identified by the provider.