PRACTICE ACTIVITY 2
Let’s practice asking the 5 why’s again:
SCENARIO:
Missing and incomplete enrollment records were a concern for one of your day care home providers during a claim consolidation review. One-third of the enrollment records were accepted from parents even though they were incomplete. When the provider receives the enrollment records, she does not review them thoroughly, instead she does a cursory review and puts them in the participant’s folder as long as they include birth dates and they are signed by a parent/guardian. Also, when new participants are enrolled, they are given two weeks to complete the records after the participant has started attending.
Can you help your day care home provider get to the root cause of their enrollment errors that lead to meal disallowances?
ANSWER
Because to be complete, at a minimum enrollment records must include information on each child’s normal days and hours of care, and the meals normally received while in care. The records must be updated annually.
ANSWER
The provider only conducts a cursory review and does not review the enrollment records thoroughly.
QUESTION
Why can’t meals be reimbursed for participants that submit enrollment forms within the two-week period?
ANSWER
Meals can only be claimed for enrolled participants. Therefore, until complete enrollment documentation is received, meals served to those participants cannot be claimed for reimbursement.
Root Cause - The day care home provider did not ensure that complete enrollment documentation was on file for the actual period that meals were served to these participants and subsequently claimed for reimbursement. Now that we have determined the root cause, we can build a corrective action plan so it does not happen again.