Consumer Directed
Service Agency
(CDSA)
Financial Errors
Monitoring Guide
DADS Form 1723, Instructions,
and Appendices
DADS Form 1723
Demographic Information
1. Consumer and Employer
2. CDSA Provider Agency
3. Monitor, Review Date, Review
Period, Review Type
Contract Monitoring Guide - Page 1
Financial Errors
Note:
1. ORIENTATION by CDSA to Employer/DRP
– Not a billed service
2. TERMINATION of CDS during first 90
days – CDSA bills:
(SFY 2004-05 / SFY 2006-07)
a) 0 – 30 Days = $118.68 / $120.00
b) 31 – 60 Days = $89.01 / $90.00
c) 61 – 90 =
$29.67 / $30.00
Contract Monitoring Guide - Page 1
ERROR #1
Reimbursement of services not
documented as being delivered
Review documentation of services delivered
with service delivery dates during the
review period for each service area in CDS:
1.
2.
3.
4.
Timesheets,
Receipt,
Invoices, and
Documentation of
a) Withholding and Accrual, OR
b) Deposit and Payment
Contract Monitoring Guide - Page 1
Error #1
Reimbursement of services not
documented as being delivered
Withholdings and Accruals
Must be billed only one time.
May be billed either:
1. At time withholding/accrual is
made, OR
2. At time of deposit/payment of the
withheld or accrued amount.
Withholding = Employee and Employer share for taxes
Accruals = Employer Unemployment Taxes, Benefits
(Bonus, Administrative Purchases)
Contract Monitoring Guide - Page 1
Error #1
Reimbursement of services not
documented as being delivered
Withholdings and Accruals
 MUST be budgeted,
 MUST be withheld or
accrued only from “WORKED”
hours
 MUST be billed only one
time.
Contract Monitoring Guide - Page 1
ERROR #3
Reimbursement of services not
delivered to the consumer.
Services delivered that were:
1. Not authorized,
2. * Not “allowable,”
3. Provided on behalf of someone
other than the consumer.
* Refer to Appendix XI and programspecific requirements/guidelines.
Contract Monitoring Guide - Page 1
ERROR #4
Reimbursement of services when
the consumer was not eligible.
Services delivered when the consumer
was not eligible for :
1. The program,
2. The *program service,
3. The funding source, or
4. Participation in CDS.
* Refer to program-specific requirements/guidelines.
Example: Not eligible for our-of-home respite.
Contract Monitoring Guide - Page 1
ERROR #5
Reimbursement in excess of spendinglimit for administrative expenses by the
employer
Budgeted amount for Administrative
Expenses:
• Budget will not be “VALID” if in excess of
spending limit established by HHSC
• Budget calculates the spending limit based
on payment rules for CDS.
Contract Monitoring Guide - Page 1
ERROR #6
CDSA is reimbursed in excess of allowable
CDSA-portion of the service rate
Budgeted amount for CDSA-portion is
calculated in the budget based on:
•
The program,
• The service, and
• The service delivery date (SFY)
Appendix VI:
SFY 2004 – 2005 and SFY 2006 - 2007
Contract Monitoring Guide - Page 1
Appendix XIV Financial Monitoring
Worksheet #1
Financial Review Month: June 2005
REIMBURSEMENT / PAYMENT HISTORY
EMPLOYER PORTION PAYMENTS
Service Begin
Date
06/01/05
06/16/05
Service End
Date
06/15/05
06/30/05
Employer Portion Totals:
Number
Units
Amount
Paid
Bill Code
$ 709.42
$ 146.26
$
$ 855.36
$ 709.12
$ 146.26
$
$ 855.36
G0717
G0717
Number
Units
Billed
Amount
Amount Paid
Bill Code
Bill Code
Type
77.74
16.03
$ 77.74
$ 16.03
$
$ 93.77
$ 77.74
$ 16.03
$
$ 93.77
G0719
G0719
CDSA
CDSA
CDSA
709.12
146.26
855.36
Billed Amount
Bill Code
Type
Employer
Employer
Employer
CDSA PORTION PAYMENTS
Service Begin
Date
06/01/05
06/16/05
Service End
Date
06/15/05
06/30/05
CDSA Portion Totals:
93.77
Appendix XIV Financial Monitoring
Worksheet # 1
Financial Review Month: June 2005
REIMBURSEMENT / PAYMENT
HISTORY
TOTAL PAYMENTS
Service
Begin Date
Service
End Date
Number
Units
06/01/05
06/15/05 855.36
93.77
06/16/05
06/30/05
Totals for Service 949.15
Category:
Billed
Amount
Amount
Paid
$ 855.36 $ 855.36
$ 93.77 $ 93.77
$ 949.15 $ 949.15
Bill
Code
Bill Code
Type
G0717
G0719
Employer
CDSA
Appendix XIV Financial Monitoring
Worksheet # 1
Financial Review Month: June 2005
REIMBURSEMENT / PAYMENT HISTORY
EQUIVALENT UNITS FOR CALENDAR REVIEW MONTH
Employer Portion Divided
Unit Amount
Into
Employer Portion
Amount Paid
Equals
Employer Portion
Equivalent Units
$9.03
/
$855.36
=
94.72
CDSA Portion
Unit Amount
Divided
Into
CDSA Portion
Amount Paid
Equals
CDSA Portion
Equivalent Units
$0.99
/
93.77
=
94.72
CDSA Portion
Equivalent Units
Equals
Variance
94.72
=
0.00
Employer
Minus
Portion
Equivalent Units
94.72
-
DADS Form 1723 –
Page 2
Financial Review Month: June 2005
Service
Group
3
Unit Type
 Hour
Day
Program
Type/Name
CBA
Employer
Portion
$9.03
Service Code
Service Category
17V
Personal Assistance Services
Total Unit
(F#5)
CDSA Portion
(F#6) CDSA Billing %
Rate
EmpPortion/
1.10=
$0.99
$10.02
10.96%
$0.82
Appendix VI – Service Groups, Service Codes, Billing Codes and Partial
Billing
Appendix VIII – Calculating Employer’s Maximum Admin. Expense Amount
Appendix VII – FY 2004 – 2005 Community-Based Payment Option
DADS Form 1723 – Page 2
Financial Review Month: June 2005
Explanation of Financial Errors
Documentation of services =
timesheet, invoice, receipt, documentation of services delivered forms, etc.
F#1. The provider agency is reimbursed for services/units, but
documentation of services is missing or the record of time is blank for
the period for which services are reimbursed. DADS applies the error to
the total amount reimbursed for the billing peri
Amount
Reimbursed:
$ 875.00
−
Amount
Documented:
$ 835.00
=
Findings
YES
NO
X
Amount Not Documented:
$ 40.00
Fiscal Audit Sample – Billing and Reimbursement History = $875.00
Review Period Timesheets - $835.00
Calculated Reimbursement Overage = $ 40.00
Appendix XIV Financial Monitoring
Worksheet # 1
Financial Review Month: June 2005
Financial Error #1: Documentation of services is missing or record of time is blank.
Calculation of non-reimbursable, excess, Employer Portion Amount (paid and accrued.)
1. Excess Employer Portion Amount for Calendar Review Month – Employees.
EMPLOYEE
Name or Initials
1
2
3
4
J. S.
B. S.
Totals:
Hours
Reimbursed
-
Reimbursable
Hours
=
80.00
16.50
-
75.00
16.50
=
=
=
=
96.90
91.90
A. Excess
Hours
A.
Under Billed
Hours
5.00
0.00
0.00
0.00
5.00
0.00
Appendix XIV Financial Monitoring
Worksheet # 1
Financial Review Month: June 2005
Calculation of non-reimbursable, excess Employer Portion Amount
(paid and accrued) for Employees.
EMPLOYEE
Name or
Initials
1 J. S.
2
3
4
A. Excess
Hours
X
5.00
X
Totals: A. 5.00
X
X
X
Actual
Hourly
Rate
=
$ 7.00
$
$
$
=
=
=
=
Excess
Gross Pay
B. Excess
$ 35.00
Employer
$
Contributions
$
for Excess
Hours
$
$ 35.00 + B.
$
Total Excess
Amount for
Employer Portion
Reimbursed for
Employees
= C.
$
Appendix XIV Financial Monitoring
Worksheet # 1
Financial Review Month: June 2005
Calculation of Employer Contributions for Excess
Hours reimbursed for Employees
Total Excess
Gross Pay
X
Per Cent
=
X
.0765
=
X
.0080
=
$ 35.00
X
.0270
=
Actual Amount of Benefits Reimbursed
for Excess Hours:
B.
Excess Employer
Contribution
$
$
$
$
2.680
.280
.945
3.750
$ 7.655
Type of Contribution
* FICA (SS/Medicare)
FUTA
SUTA
Benefits
* SS =
MDCR =
6.20%
1.45%
Gross Pay = # Hours Worked times Hourly Rate + Benefits + Overtime
Appendix XIV Financial Monitoring
Worksheet # 1
Financial Review Month: June 2005
Calculation of Employer Contributions for Excess
Hours reimbursed for Employees
EMPLOYEE
Name or Initials
1 J. S.
2
3
4
A.
Excess
Hours
X
5.00
X
Totals: A. 5.00
X
X
X
Actual
Hourly
Rate
=
$ 7.00
$
$
$
=
=
=
=
Excess
Gross Pay
$ 35.00
$
$
$
$ 35.00
B. Excess
Employer
Contributions
for Excess
Hours
+
B.
$ 7.66
C. Total Excess
Amount for
Employer Portion
Reimbursed for
Employees
= C.
$ 44.32
Gross Pay = # Hours Worked times Hourly Rate + Benefits + Overtime
Appendix XIV Financial Monitoring
Worksheet # 5 and # 6
Financial Error #5:
Reimbursement in excess of the maximum amount allowed for
employer-related administrative services. Calculation of non-reimbursable,
excess, Employer Portion Amount (paid and accrued.)
1. Calculation of Maximum Employer Administrative Costs for Calendar Review Month
Employer Administrative Expense
Employer Maximum Amount per Unit
Reimbursable Employer Unit Equivalent for Month
Maximum Reimbursable Employer Administrative Cost / Month
No Administrative Expense
Budgeted for June 05
Amount
$ 0.82/Unit
X 91.90/ Units
= $ 75.36
Appendix XIV Financial Monitoring
Worksheet # 5 and # 6
Financial Error #5 : Reimbursement in excess of the maximum amount allowed
for employer-related administrative services. Calculation of non-reimbursable,
excess, Employer Portion Amount (paid and accrued.)
2. Calculation of Available (Current Month and Accrued) Employer Administrative Costs
Maximum Reimbursable Employer Administrative Cost / Month
$ 00.00
Accrued Amount Remaining from Prior Months + $ 45.84
Total Reimbursable Employer Administrative Cost = $ 45.84
3. Calculation of Excess Employer Administrative Cost Reimbursed
Total Reimbursable (Available + Accrued) Employer Administrative
$ 45.84
Actual Employer Administrative Amount Reimbursed - $ 00.00
F#5 Excess Amount of Employer Administrative Cost = $ 0.00
Appendix XIV Financial Monitoring
Worksheet # 5 and #6
Financial Review Month: June 2005
Financial Error #6: Reimbursement in excess of the allowable CDSA Portion.
Calculation of non-reimbursable, excess, CDSA Portion Amount paid.
1. Calculation of the total amount that the CDSA can bill for the CDSA Portion
Category
Amount
Total Reimbursable Employer Amount for the Month
$ 811.04
CDSA Billing % of Employer Portion
X
CDSA Portion Reimbursable Amount
= $ 88.91
.10963 %
2. Calculation of excess billing or under billing by the CDSA for the CDSA Portion
CDSA Portion Reimbursable Amount
Reimbursed CDSA Portion
F#6 Excess CDSA Portion Amount Reimbursed
CDSA Portion Under Billed
$ 88.91
--
=
$ 93.77
$ 4.86
$ 0.00
DADS Form 1723 –
Page 2
Financial Review Month: June 2005
F# 5. The provider agency is reimbursed in excess of the maximum amount
allowed for employer-related administrative expenses. (Employer-Related
Administrative Expenses: advertising/recruiting, training, criminal investigation
checks, equipment, copy, mail, travel costs, supplies, uniforms, Hep B
vaccinations, CPR) DADS applies the error to the total amount reimbursed in
excess of the maximum amount allowed and/or budgeted for the cost.
[Employer Portion / 1.10]
Maximum
Admin: $ 0.00
$ 45.84
Accrued + $ 45.84
Total =
−
Amount
Reimbursed:
$ 0.00
=
Excess Amount
Reimbursed:
$ 0.00
DADS Form 1723 –
Page 2
Financial Review Month: June 2005
F# 6. The provider agency is reimbursed in excess of the
allowable CDSA portion. DADS applies the error to the total
X
dollar amount reimbursed in excess of the allowable CDSA
portion.
CDSA Reimbursed
Amount:
$ 93.77
−
Reimbursable
Amount:
$ 88.91
=
Excess Amount
Reimbursed:
$ 4.86
Note: The calculation worksheet is available in Appendix XIV of the Consumer Directed
Services Handbook.
DADS Form 1723 –
Texas Department
of Aging and
Disability
Services
Page 1
Form 1723
August 2005
Consumer Directed Services
Consumer Directed Services Agency (CDSA)
Financial Errors
Consumer Name
Sue Smith
Medicaid No.
123456789
Date of Review
12/05/05
Review Month
06 / 2005
Case Record Summary of Financial Errors
100% Financial Recoupment
Error
No.
Service
Code
1
6
17V
17V
Service
Category
CBA - PAS
CBA - PAS
Billing Type:
Employer/
CDSA
Employer
CDSA
Billing
Code
Total
Recoupment
G0717
G0719
$ 44.32
$ 4.86
Total Recoupment Amount:
$ 49.18
DADS Form 3687 –
Texas Department
of Aging and
Disability
Services
Page 1
Form 3687
June 2001
Provider Agency Findings of Fiscal
Monitoring Review
SERVICE CODE
1.
FINANCIAL AMOUNT
TO BE RECOUPED
17V / G0717 CBA
$ 249.18
17V / G0719 CBA
$ 27.32
2.
ADMINISTRATIVE
AMOUNT
TO BE RECOUPED
3.
TOTAL (Admin. &
Financial)
AMOUNT
11B / G0133
$ 35.48
$ 284.66
$ 31.21
$ 31.21
$ 35.48
11B / G0172
$ 3.89
$ 3.89
1A
2A
A. Total to be
Recouped
$
315.87
B. Total Dollar Amt.
Reimbursed for
Clients Reviewed
$
5,061.85
C. Error Rate
(1A ÷ B)
6.24 %
+
$
3A
0.00
=
$
315.87
DADS Form 3687 –
Texas Department
of Aging and
Disability
Services
Page2
TYPE OF FINANCIAL ERROR
TOTAL
REIMBURSEMENT
AMOUNT

(From Item C – Financial
Errors Standard Form)
SERVICE CODE
CLIENT NAME
(1)
(2)
(3)
(4)
17V / G0717
Sue Smith
$ 44.32
1
17V / G0719
Sue Smith
$ 4.86
6
17V / G0717
Bob Travis
$ 125.32
1
17V / G0719
Bob Travis
$ 13.74
6
17V / G0717
Jack Jones
$79.54
1
17V / G0719
Jack Jones
$ 8.72
6
11B / G0133
Bob Travis
$ 35.48
2
11B / G0172
Bob Travis
$ 3.89
6
Employer Portion
$ 284.66
CDSA Portion
$ 31.21
6
Form 3687
June 2001
Reimbursement
CDSA Responsibilities
1. Budget Verification and Validation
Verification:








Spending Limits
Withholdings
Benefits
Hourly Wages
Overtime
Allowable
Program-specific
Funding Source
Validation:
Budget:


“VALID” Status
Budgeted Item
Service Provider:
 Qualified
 Eligible
Documentation of Service
Delivery – Program
Specific and CDS Criteria
Reimbursement
CDSA Responsibilities
2. Spending Verification and Validation
Verification:







Budgeted
Allowable
Reasonable
Necessary
Year-to-Date
Program-specific
Funding Source
Validation:
Service Provider:


Qualified / Maintained
Eligible / Maintained
Documentation of Service
Delivery – Timesheets,
Invoices, and Receipts



Program Specific Criteria
CDS Criteria
Employer-Approved
CDSA
Financial
Monitoring
Comments
Q&A