WIPA CHART AUDIT by Zothedamaga

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									WIPA CHART REVIEW
CWIC:___________________________________________ CLIENT FILE:____________________________________ REVIEWER:______________________________________ Forms Documentation: Form Initial Intake Releases of Information BPQY Benefit Summary & Analysis Work Incentive Plan Contact Log Wage Reports (if applicable) Referral forms (if applicable) Other (as needed) Verification: Benefit SSA benefits (SSI, SSDI, CDB or DWB) Earnings TWP usage ISM – deeming, PMV, VTR Medicaid (209b states, medwaiver) Medicare Savings programs (QMB, SLMB) and/or Part D Low Income Subsidy Food Stamps Housing Subsidies Veteran’s benefits TANF Unemployment Worker’s Compensation or other Public Disability Benefit Other Quality Content: Question Do the case notes document ‘just the facts’ of services rendered? Are all the items identified in the initial intake covered Yes Yes No Comments DATE:__________________

No

Verified By

Comments

Yes

No

Comments

sufficiently in the BSA? Are the recommendations made in the BSA specific and appropriate to the goal? Does the information in the BSA flow in an understandable manner? Is the advisement accurate and are appropriate calculation charts included? Does the WIP reflect appropriate action steps as identified from the BSA? Is there any missing information in either the BSA or the WIP? Are appropriate updates to the BSA and WIP tracked and included? Are all earnings reports and work incentives documentation accurate and current? Is the file information presented in a clear and organized manner so that another CWIC could step in as needed? Is there a clear plan for ongoing follow up? Are contacts with SSA and other relevant agencies noted and tracked? Comments and Corrective Actions:


								
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