Gold Star Monitoring for NC Providers
“The Department of Health and Human Services Gold Star Provider Monitoring is a process used to promote North Carolina’s commitment to ensuring high quality services for individuals with mental health, developmental disabilities, and substance abuse issues.”
Gold star monitoring is used for Medicaid and state funded behavioral health services and is used by all LME/MCOs. Prior to Gold Star, Local Management Entities (LMEs) did annual site visits but with the waiver, Gold Star Monitoring was established to audit providers and agencies. Gold Star Monitoring is intended to keep providers in compliance with rules and regulations. The monitoring will look at regulation compliance, quality performance, documentation and integrity of billing. There are two different tools for monitoring- one for licensed independent providers (LIPs) and one for provider agencies. LIP monitoring has two levels, “Preferred” and “Routine.” “Routine” monitoring is done annually. Those who remain in good standing will be reviewed every three years under the “Preferred” level. Monitoring of agencies will be done differently than LIPs depending on the services provided by that agency.
For training, monitoring tools and more, click here.
Tips to ensure you are in compliance and to help your monitoring go smoothly:
- Avoid fraud and abuse in your practice. See NASW-NC’s resource for Fraud and Abuse: Why Professionals Should Care.
- Have good documentation.
- Make sure the service billed is in your documentation.
- Sign off with your credentials behind your name.
- Make sure you have prior authorizations before you bill.
NASW-NC Social Work Blog 