From NewsChannel 9: Tennessee's top auditor says a clinic in Athens, Tennessee did not accurately report visits and payments to TennCare, which re
From NewsChannel 9: Tennessee’s top auditor says a clinic in Athens, Tennessee did not accurately report visits and payments to TennCare, which resulted in a net overpayment of more than $300,000.
Management for the Women’s Center of Tennessee on Meadows Drive responded to the audit by saying while it concurred with its findings, they found several “concerning” factors about how it was conducted.
Read the full audit below.
Tennessee Comptroller Jason Mumpower says his auditing team determined that the Women’s Center of East Tennessee overreported 1,721 TennCare Prospective Payment System visits and $33,961 on payments between April 2017 and March 2022.
The report says the clinic did so by including on its quarterly settlement requests
ineligible visits and payments, such as unsupported visits, denied visits, visits for dual enrollees, duplicate visits, and encounters that do not meet the definition of a visit wit ha qualifying provider.
Auditors say they also identified visits and payments that weren’t reported in the correct quarter based on the date of service.
The overreporting of visits resulted in increased TennCare quarterly settlements to the clinic, which were partially offset by the overreported payments.
The report recommends that Women’s Center of East Tennessee establish procedures “to ensure that it submits accurately quarterly settlement reports” to the state, and that they should “reflect the actual paid TennCare PPS visits and payments for each quarter reported.”
The clinic’s management was given a chance to respond to the letter. They said they do concur with the report’s findings, but
…we do wish to outline several factors that we find concerning and that we feel should be considered moving forward.
Those issues include several examples where a denied claim amounted to $0.00, meaning that primary insurance had already covered the allowed amount for the service, which they feel ‘wrongfully counted against us.’
Management said the Comptroller’s office also didn’t provide enough information ahead of time for them to do the procedures correctly and legally.
The reply also said that the most inappropriately counted visits and payments were during the COVID-19 pandemic, which was when the clinic was experiencing staffing shortages and a higher burden for remaining employees, which
..resulted in fatigued or rushed personnel compiling the information and therefore unintentionally reporting incorrectly.
The reply concluded that moving forward, the clinic has already made and will make changes to ensure compliance, which include more training, closer communication with the Comptroller’s office, and working with their medical records software supplier.
