Audit report, schedule of reimbursable costs and agency visit statistics, Chattahoochee Valley Home Health Care, Inc. (Georgia office), Columbus, Georgia, Medicaid provider no. 00186425A, for the year ended June 30, 1994, Georgia Department of Medical Assistance [June 30, 1994]

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STATE OF GEORGIA DEPARTMENT OF AUDITS
254 WASHINGTON STREET ATLANTA, GEORGIA 30334

AUDIT REPORT SCHEDULE OF REIMBURSABLE COSTS
AND AGENCY VISIT STATISTICS CHATTAHOOCHEE VALLEY
HOME HEALTH CARE, INC. (GEORGIA OFFICE) COLUMBUS, GEORGIA
MEDICAID PROVIDER NO. 00186425A FOR THE YEAR ENDED JUNE 30, 1994 GEORGIA DEPARTMENT OF MEDICAL ASSISTANCE
Report Prepared By: State ofGeorgia
Department ofAudits andAccounts Medicaid and Local Govemment Audits Division
254 Washington Street, S. W, Suite 322 Atlanta, Georgia 30334-8400 (404) 656-2006

CHAITAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) - TABLE OF CONTENTS -

AUDITOR'S REPORT

V

SCOPE OF THE AUDIT

SCHEDULE OF REIMBURSABLE COSTS

2

NOTES TO SCHEDULE

3

SUMMARY OF FIELD AUDIT ADWSTMENTS

5

EXPLANATION OF FIELD AUDIT ADWSTMENTS

7

CLAUDE L VICKERS
STATE AUDITOR

DEPARTMENT OF AUDITS
254 Washington Street, S.W., Suite 214 Atlanta, Georgia 30334-8400
Telephone (404) 656-2006 Facshnile (404) 656-7535
June 23, 1995

Home Health Services Program Division ofNon-Institutional Reimbursement Georgia Department of Medical Assistance 2 Peachtree Street, NW 25th Floor Atlanta, Georgia 30303-3159
Ladies and Gentlemen:
We have audited parts I and II of the Medicaid Cost Data Form filed with the Georgia Department ofMedical Assistance under the Title XIX Medicaid Program by Chattahoochee Valley Home Health Care, Inc., d/b/a Chattahoochee Valley Home Health Care, Inc. (Georgia office), for the year ended June 30, 1994, and have compiled the accompanying Schedule of Reimbursable Costs and Agency Visit Statistics based on our audit. The Medicaid Cost Data Form is the responsibility of the management of Chattahoochee Valley Home Health Care, Inc., d/b/a Chattahoochee Valley Home Health Care, Inc. (Georgia office). Our responsibility is to determine if the reimbursable costs and agency visit statistics reported on the Medicaid Cost Data Form are reasonable and allowable, in all material respects, in accordance with the federal and state laws, regulations, policies and procedures governing the Georgia Home Health Services Program. It is also our responsibility to report the results of our audit, including any required adjustments to parts I and II of the Medicaid Cost Data Form, to the Georgia Department of Medical Assistance.
We conducted our audit in accordance with the Home Health Agency Audit Program approved by the Georgia Department of Medical Assistance. Our audit included examining and evaluating, on a test basis, evidence supporting the amounts and disclosures in Parts I and II of the Medicaid Cost Data Form. Our audit also included assessing the accounting principles used and significant estimates made by management. We believe our audit provides a reasonable basis for our report.
V

As described in Note I ofthe Notes to Schedule, the accompanying Schedule ofReimbursable Costs and Agency Visit Statistics was prepared to present the data necessary for the Georgia Department of Medical Assistance to determine Medicaid reimbursement and is not intended to be a presentation in accordance with generally accepted accounting principles, nor is it intended to be a complete presentation of the assets, liabilities, revenues and expenses of Chattahoochee Valley Home Health Care, Inc., d/b/a Chattahoochee Valley Home Health Care, Inc. (Georgia office), on the basis described.
In our opinion, the "adjusted totals" column in the accompanying Schedule of Reimbursable Costs and Agency Visit Statistics - which was compiled by us and reflects any adjustments to parts I and II of the Medicaid Cost Data Form required as a result of our audit - presents fairly, in all material respects, the reimbursable costs and agency visit statistics of Chattahoochee Valley Home Health Care, Inc., d/b/a Chattahoochee Valley Home Health Care, Inc. (Georgia office), for the year ended June 30, 1994, on the basis of accounting described in Note I.
This report is intended to be used solely in connection with the administration of the Georgia Department of Medical Assistance Home Health Services Program and is not to be used or relied upon for any other purpose.
Respectfully submitted,
~~
Claude L. Vickers State Auditor CLV/kr/ca
Vll

CHATTAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) SCOPE OF THE AUDIT
FOR THE YEAR ENDED JUNE 30, 1994
This audit was performed in order to determine if the reimbursable costs and agency visit statistics reported in parts I and II ofthe Medicaid Cost Data Form are reasonable and allowable, in all material respects, in accordance with the federal and state laws, regulations, policies and procedures governing the Georgia Medicaid Program, and to report to the Georgia Department of Medical Assistance (DMA) any adjustments to parts I and II of the Medicaid Cost Data Form required as a result of our audit.
In order to accomplish these objectives, we examined, on a test basis, evidence supporting the amounts and disclosures in parts I and II of the Medicaid Cost Data Form, and assessed the accounting principles used and significant estimates made by management. Tested transactions and accounts were evaluated for compliance with DMA Policies and Procedures for Home Health Services and for compliance with federal laws and regulations applicable to the Title XIX Medicaid Program. Any adjustments to parts I and II of the Medicaid Cost Data Form required as a result of our audit are included in this report.
Costs reported in part II of the Medicaid Cost Data Form include both the direct costs of providing the reimbursable services and the indirect costs allocated to them. These indirect costs result from the step-down of the general service costs on Worksheet B of the Medicare cost report (HCFA-1728). The costs associated with these general service cost centers were included in our audit and adjustments to these cost centers, if any, are shown in the accompanying Summary of Field Audit Adjustments.
Our audit included a limited consideration of the organization's internal control structure sufficient to plan the audit. Our consideration for this limited purpose would not necessarily disclose all reportable conditions in the internal control structure. Accordingly, we do not express an opinion on the internal control structure.
1

CHATIAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) SCHEDULE OF REIMBURSABLE COSTS AND AGENCY VISIT STATISTICS FOR THE YEAR ENDED JUNE 30, 1994

REIMBURSABLE COSTS

PER COST DATA FORM
AS FILED

Skilled Nursing Care Physical Therapy Speech Therapy Occupational Therapy Home Health Aide

$

1,165,448

128,185

23,386

11,954

669 888

Total Reimbursable Costs $

1 228 861

FIELD AUDIT ADJUSTMENTS

$

(2,681)

(759)

(417)

(118)

(12,037)

$

(] 6 0] 2)

ADJUSTED TOTALS
$ 1,162,767 127,426 22,969 11,836 657 851
$ 1 282 842

MEDICAID VISITS
Skilled Nursing Care Physical Therapy Speech Therapy Occupational Therapy Home Health Aide
Total Medicaid Visits

1,257 130 34 31 771
2 223

(12)

1,245

0

130

(3)

31

0

31

0

771

(] 5)

2 208

TOTAL AGENCY VISITS
Skilled Nursing Care Physical Therapy Speech Therapy Occupational Therapy Home Health Aide
Total Agency Visits

11,778 1,787 320 177
30 983
45 045

(10)

11,768

(3)

1,784

(2)

318

0

177

0

30 983

(] 5)

45 030

2

CHATTAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) NOTES TO SCHEDULE
FOR THE YEAR ENDED JUNE 30, 1994
NOTE 1: SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES ENTITY INFORMATION
Chattahoochee Valley Home Health Care, Inc. (Georgia office), provides home health services to residents ofChattahoochee, Harris, Marion, Meriwether, Muscogee, Stewart, Talbot, Troup, and Webster counties. The residents of this nine county area are served through the provider's office in Columbus, Georgia. The agency was operated as a component of Chattahoochee Valley Home Health Care, Inc., a chain organization which filed a Home Office Cost Data Form with DMA for the year ended June 30, 1994.
BASIS OF ACCOUNTING The Medicaid Cost Data Form and the associated Schedule of Reimbursable Costs and
Agency Visit Statistics, hereinafter referred to as the Schedule, were prepared in conformity with the Principles of Reimbursement for Provider Cost published by the Secretary of Health and Human Services as modified by the provisions of Policies and Procedures for Home Health Services published by the Georgia Department of Medical Assistance. This basis of accounting required by the Medicaid Program differs from generally accepted accounting principles. Consequently, the information presented in this report reflects only the allowable reimbursable costs and agency visit statistics required for DMA to determine the provider's Medicaid reimbursement rate. This report does not reflect the provider's financial position or the results of its operations; it is intended to be used solely in connection with the administration of the Georgia Department ofMedical Assistance Medicaid Program and is not to be used or relied upon for any other purpose.
NOTE 2: FIELD AUDIT ADJUSTMENTS The Field Audit Adjustments column on the Schedule is provided to show the net effect of
adjustments made during the field audit process. The audit adjustments made as a result of this audit are shown on the Summary ofField Audit Adjustments and are explained in the Explanation of Field Audit Adjustments.
NOTE 3: MEDICAID AGGREGATE COST PER VISIT The Schedule ofReimbursable Costs and Agency Visit Statistics shows the allowable costs
and visit statistics claimed on the cost data form, any field audit adjustments made, and the resulting totals after adjustment. In the summary on the following page, these data have been used to calculate the Medicaid aggregate cost per visit in the same manner used by DMA to calculate the per visit reimbursement rate. The aggregate cost per visit shown does not include any inflation factor, incentives, or supply add-on; nor does it necessarily reflect the amounts which will be used by DMA for rate-setting purposes.
3

CHATTAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) NOTES TO SCHEDULE
FOR THE YEAR ENDED JUNE 30, 1994

Skilled Nursing Care Physical Therapy Speech Therapy Occupational Therapy Home Health Aide
Total

TOTAL AGENCY
COST

TOTAL AGENCY
VISITS

AGENCY COST
PER VISIT

MEDICAID VISITS

MEDICAID COST

MEDICAID VISITS

AGGREGATE COST
PER VISIT

$ 1,162,767 127,426 22,969 11,836 657 851
$ 1,982,849

11,768 $ 1,784 318 177
30983
45,030

98.81 71.43 72.23 66.87 21.23

1,245 $ 130 31 31 771
2,208 $

123,018 9,286 2,239 2,073 16,368
152,984

2,208 $

69.29

CHATTAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) SUMMARY OF FIELD AUDIT ADJUSTMENTS FOR THE YEAR ENDED JUNE 30, 1994

ADWSTMENT NUMBER

REIMBURSABLE COSTS

SKILLED NURSING CARE

1

Step Down of General Service Costs

$ (12,122)

2

Incorrect Expense Classifications

9 441 $ (2,681)

PHYSICAL THERAPY

1

Step Down of General Service Costs

$ (1,559)

2

Incorrect Expense Classifications

800

(759)

SPEECH THERAPY

1

Step Down of General Service Costs

(417)

OCCUPATIONAL THERAPY

1

Step Down of General Service Costs

$

(168)

2

Incorrect Expense Classifications

50

(118)

HOME HEALTH AIDE

1

Step Down of General Service Costs

$ (11,987)

2

Incorrect Expense Classifications

(50)

(12,037)

CAPITAL RELATED - BUILDING AND FIXTURES

1

Step Down of General Service Costs

$

714

3

Excess Depreciation

(714)

0

CAPITAL RELATED - MOVABLE EQUIPMENT

1

Step Down of General Service Costs

$

338

4

Costs Not Related to Patient Care

(338)

0

5

CHATTAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) SUMMARY OF FIELD AUDIT ADJUSTMENTS FOR THE YEAR ENDED JUNE 30, 1994

ADJUSTMENT NUMBER

REIMBURSABLE COSTS (continued)

ADMINISTRATIVE AND GENERAL

I

Step Down of General Service Costs

$ 26,401

2

Incorrect Expense Classifications

(10,241)

4

Costs Not Related to Patient Care

(13,567)

5

Lack of Sufficient Documentation

(480)

6

Allocations from Home Office

(2,113)

0

Net Adjustment to Reimbursable Costs

$ ()6 012)

MEDICAID VISITS

7

Skilled Nursing Care

(12)

7

Speech Therapy

(3)

Net Adjustment to Medicaid Visit Statistics

(15)

TOTAL AGENCY VISITS

8

Skilled Nursing Care

(10)

8

Physical Therapy

(3)

8

Speech Therapy

(2)

Net Adjustment to Total Agency Visit Statistics

(15)

6

CHATTAHOOCHEE VALLEY HOME HEALTH CARE, INC. (GEORGIA OFFICE) EXPLANATION OF FIELD AUDIT ADJUSTMENTS FOR THE YEAR ENDED JUNE 30, 1994

ADWSTMENT NUMBER

EXPLANATION

1

STEP DOWN OF GENERAL SERVICE COSTS

General service costs of this provider are stepped down to the other cost centers on Worksheet B ofthe Medicare cost report. Adjustments were made to the general service costs claimed. These adjustments must be stepped down to the other cost centers in the same way as were the claimed costs. This adjustment is made to step down the net adjustments to the general service cost centers to the other cost centers. (Instructions to Medicare Cost Report Form 1728)

COST CENTER Skilled Nursing Care Physical Therapy Speech Therapy Occupational Therapy Home Health Aide Capital Related - Building and Fixtures Excess Depreciation Capital Related - Movable Equipment Costs Not Related to Patient Care Administrative and General Incorrect Expense Classifications $ Costs Not Related to Patient Care Lack of Sufficient Documentation Allocations from Home Office

$
10,241 13,567
480 2 113

(12,122) (1,559) (417) (168)
(11,987) 714 338
26 401

Net Adjustment to Reimbursable Costs (1)

$

] 2QQ

(1) A total of $(1,200) was stepped down to other cost centers which do not receive Medicaid reimbursement and are, therefore, not included in this report.

7

ADJUSTMENT NUMBER

EXPLANATION (continued)

2

INCORRECT EXPENSE CLASSIFICATIONS

Documentation examined during the audit showed that some ofthe expenses were not properly classified. Federal regulations provide that cost information as developed by the provider must be current, accurate, and in sufficient detail to support payments made for services rendered to beneficiaries. This adjustment is made to reclassify costs to the appropriate cost centers. (HCFA 15-2304; Instructions to Cost Report)

COST CENTER Skilled Nursing Care Contracted Services Physical Therapy Contracted Services Occupational Therapy Travel Expenses Home Health Aide Travel Expenses Administrative and General Contracted Services

$

9,441

800

50

(50)

(10,241)

Net Adjustment to Reimbursable Costs

$

Q

3

EXCESS DEPRECIATION

Documentation examined during the audit in support of fixed assets and depreciation showed that either the property was not included in the proper class or depreciation was not calculated in accordance with AHA guidelines. Federal regulations provide for the use of minimum required asset lives. This adjustment is made to reduce reimbursable costs claimed by the amount of depreciation expense claimed in excess oftotal allowable. (HCFA 15-104.17)

COST CENTER Capital Related - Building and Fixtures

$

(714)

8

ADWSTMENT NUMBER

EXPLANATION (continued)

4

COSTS NOT RELATED TO PATIENT CARE

Expenses claimed in the cost report included payments which were not considered to be for patient care operations. Federal regulations provide that costs which are not appropriate or necessary and proper in developing and maintaining the operation of patient care facilities and activities are not allowable in computing reimbursable costs. This adjustment is made to remove the non-patient care expenses from reimbursable costs. (HCFA 15-2102.3;DMA Policies and Procedures Section 1001.2, (t), (h))

Items Advertising National Association Dues Phenix City Agency Landscaping Expense Pregnancy Related Services Program Expenses

$ (1,866) (238) (75)
(11,726)

$ (]3 905)

COST CENTER Capital Related - Movable Equipment Administrative and General

$

(338)

(13,567)

Total Adjustment to Reimbursable Costs

$ (]3 905)

5

LACK OF SUFFICIENT DOCUMENTATION

Some ofthe expenses shown on the cost report were not supported by adequate documentary evidence. Federal regulations provide that cost information as developed by the provider must be current, accurate, and in sufficient detail to support payments made for services rendered to beneficiaries. This adjustment is made to remove the undocumented expenses from reimbursable costs. (HCFA 15-2304)

COST CENTER Administrative and General

$

(480)

9

ADJUSTMENT NUMBER

EXPLANATION (continued)

6

ALLOCATIONS FROM HOME OFFICE

The provider was a component of a chain organization for the year ended June 30, 1994. Adjustments were made to the Home Office Cost Data Form filed in connection with the Medicaid Home Health Services Program. This adjustment is made to correct reimbursable costs for the portion of the home office audit adjustments which are allocated to the provider. (HCFA 15-2150)

COST CENTER Administrative and General Pooled Costs

$ (2 113)

7

MEDICAID VISIT STATISTICS

Visit logs examined during the audit showed that the provider made 2,208 total visits applicable to Medicaid Home Health Services rather than the 2,223 shown on the cost data form. An adjustment of 15 visits has been made to correct the statistical information.

MEDICAID VISITS BY DISCIPLINE

Skilled Nursing Care

(12)

Speech Therapy

(3)

Total Adjustment to Medicaid Visit Statistics

(15)

8

TOTAL AGENCY VISIT STATISTICS

Visit logs examined during the audit showed that the provider made 45,030 total visits applicable to Medicaid reimbursable disciplines rather than the 45,045 shown on the cost data form. An adjustment of 15 visits has been made to correct the statistical information.

ADIDSTMENT
NUMBER

EXPLANATION (continued)

AGENCY VISITS BY DISCIPLINE

Skilled Nursing Care

(10)

Physical Therapy

(3)

Speech Therapy

(2)

Total Adjustment to Total Agency Visit Statistics

(] 5)

11