[{"data":1,"prerenderedAt":217},["ShallowReactive",2],{"\u002Fresources\u002Fhcbs-audit-readiness-checklist":3},{"id":4,"title":5,"accentColor":6,"assetType":7,"body":8,"description":202,"extension":203,"icon":204,"meta":205,"navigation":206,"order":207,"path":208,"readTime":209,"seo":210,"states":211,"stem":213,"type":214,"updated":215,"__hash__":216},"toolkit\u002Fresources\u002Fhcbs-audit-readiness-checklist.md","HCBS Medicaid Audit-Readiness Checklist","bg-primary-500","checklist",{"type":9,"value":10,"toc":190},"minimark",[11,20,23,28,48,52,73,77,91,95,106,110,121,125,136,140,155,159,181,184],[12,13,14,15,19],"p",{},"Audits rarely fail because the care was bad. They fail because the ",[16,17,18],"strong",{},"record can't prove the care happened",". The goal of audit readiness is simple: every billed unit should be traceable to a complete, signed, time-stamped record that matches the authorized plan of care.",[12,21,22],{},"Use this checklist as a self-audit. Work through it for a random sample of recent claims, the same way a reviewer would, and fix what you find before someone else finds it.",[24,25,27],"h2",{"id":26},"_1-eligibility-authorization","1. Eligibility & authorization",[29,30,31,35,38,45],"ul",{},[32,33,34],"li",{},"Each individual has a current Medicaid eligibility determination on file for every date of service billed.",[32,36,37],{},"A current, signed plan of care (or service plan \u002F ISP) authorizes the specific service, frequency, and number of units billed.",[32,39,40,41,44],{},"Services billed fall ",[16,42,43],{},"within"," the authorized dates, units, and service definitions, no billing before the plan's start date or after it expires.",[32,46,47],{},"Any service limits, prior authorizations, or level-of-care determinations are documented and unexpired.",[24,49,51],{"id":50},"_2-documentation-completeness","2. Documentation completeness",[29,53,54,61,64,67,70],{},[32,55,56,57,60],{},"A service note exists for ",[16,58,59],{},"every"," billed unit, no billed service without a matching note.",[32,62,63],{},"Each note identifies the individual, the date, the start and end time, the specific service delivered, and the staff member who delivered it.",[32,65,66],{},"Notes describe what actually happened in enough detail to justify the service and tie back to the individual's goals, not just \"client doing well.\"",[32,68,69],{},"Notes are signed and dated by the staff member who provided the service, with credentials where required.",[32,71,72],{},"Late entries and corrections are clearly marked as such, with the date of the correction and the author, never overwritten or backdated.",[24,74,76],{"id":75},"_3-time-units","3. Time & units",[29,78,79,82,85,88],{},[32,80,81],{},"Documented start\u002Fend times support the number of units billed (units are not rounded up beyond what the time supports).",[32,83,84],{},"No overlapping services: the same staff member is not billed as serving two people at the same time (unless a group ratio is authorized and documented).",[32,86,87],{},"Group services document the staff-to-individual ratio and each participant's individual record.",[32,89,90],{},"Travel, no-shows, and missed visits are handled per your state's billing rules and are not billed as delivered services.",[24,92,94],{"id":93},"_4-staff-qualifications-training","4. Staff qualifications & training",[29,96,97,100,103],{},[32,98,99],{},"Every staff member who delivered a billed service met the qualification requirements for that service on the date it was delivered.",[32,101,102],{},"Required background checks, certifications, and competency training were current on each date of service.",[32,104,105],{},"Training records (initial and annual) are on file and retrievable.",[24,107,109],{"id":108},"_5-electronic-visit-verification-evv","5. Electronic Visit Verification (EVV)",[29,111,112,115,118],{},[32,113,114],{},"For services subject to EVV, every visit captures the six federally required data elements (see the EVV Readiness Guide).",[32,116,117],{},"EVV records reconcile with billed claims, no claims without a matching verified visit.",[32,119,120],{},"Manual edits to EVV records are documented with a reason and an audit trail.",[24,122,124],{"id":123},"_6-health-safety-incidents","6. Health, safety & incidents",[29,126,127,130,133],{},[32,128,129],{},"Required incident reports were filed within your state's timeframe and are on file.",[32,131,132],{},"Follow-up actions from incidents are documented and closed out.",[32,134,135],{},"Required health and safety items (e.g., medication administration records where applicable) are complete and signed.",[24,137,139],{"id":138},"_7-records-retention-retrieval","7. Records retention & retrieval",[29,141,142,145,152],{},[32,143,144],{},"Records are retained for at least your state's required retention period (commonly 5–10 years, confirm yours).",[32,146,147,148,151],{},"You can produce a complete record for any requested claim ",[16,149,150],{},"within the time an auditor allows"," (often days, not weeks).",[32,153,154],{},"Records are backed up and protected, and access is limited to authorized staff (HIPAA).",[24,156,158],{"id":157},"how-to-run-a-mock-audit","How to run a mock audit",[160,161,162,165,168,175,178],"ol",{},[32,163,164],{},"Pull a random sample of 10–20 claims from the last 90 days across different services and staff.",[32,166,167],{},"For each claim, try to assemble the complete proof: authorization, note, time record, EVV record, staff qualification.",[32,169,170,171,174],{},"Score each claim pass\u002Ffail and log ",[16,172,173],{},"why"," any failed.",[32,176,177],{},"Group the failures by root cause (missing signatures, time mismatches, late notes), that's your corrective-action plan.",[32,179,180],{},"Re-run the sample after fixes to confirm the gap is closed.",[182,183],"hr",{},[12,185,186],{},[187,188,189],"em",{},"This checklist provides general, federal\u002FCMS-level guidance for HCBS providers and is not legal advice. Medicaid documentation, retention, and billing rules vary by state and by waiver program, always verify the specific requirements of your state Medicaid agency and managed care organizations before relying on it.",{"title":191,"searchDepth":192,"depth":192,"links":193},"",2,[194,195,196,197,198,199,200,201],{"id":26,"depth":192,"text":27},{"id":50,"depth":192,"text":51},{"id":75,"depth":192,"text":76},{"id":93,"depth":192,"text":94},{"id":108,"depth":192,"text":109},{"id":123,"depth":192,"text":124},{"id":138,"depth":192,"text":139},{"id":157,"depth":192,"text":158},"A practical, walk-through checklist for HCBS and IDD agencies preparing for a Medicaid record review, PERM audit, or state program-integrity audit. Use it to find gaps before an auditor does.","md","i-heroicons-clipboard-document-check",{},true,1,"\u002Fresources\u002Fhcbs-audit-readiness-checklist",9,{"title":5,"description":202},[212],"All states","resources\u002Fhcbs-audit-readiness-checklist","Checklist","2026-06-05","PArkcgsi9eKhVkAAa2OEZdPbN557qjWO1xEftZwlvTs",1790093086211]