Why Documentation is the #1 Thing That Will Protect Your Business in an Audit

How AFC and Waiver Providers Can Stay Compliant, Confident, and Audit-Ready in 2025

No matter how caring your staff is or how beautiful your facility looks, if your documentation is weak, your business is at risk.

For Adult Foster Care (AFC) homes, Home for the Aged (HFA) facilities, and MI Choice Waiver providers in Michigan, documentation isn’t just paperwork — it’s protection.

In this post, we’ll explore why documentation is the most powerful tool you have to survive (and thrive) through audits from LARA, MDHHS, A&D Home Health Care, or Region VII AAA, and what you can do to improve it starting today.

🚨 The Audit Reality: If It’s Not Documented, It Didn’t Happen

LARA, A&D, Region VII AAA, and MDHHS don’t evaluate your intentions — they evaluate your evidence.

No matter how well you know your residents or how often you train your staff, if it’s not:

• Written down

• Signed

• Time-stamped

• Filed properly

…it’s as if it never happened.

🔍 What Auditors Are Looking For (and Why It Matters)

Here are some high-risk areas where missing documentation can trigger:

• Corrective action plans

• License violations

• Denied Medicaid payments

• Termination from provider networks

These risks apply whether your oversight agency is Region VII AAA, A&D Home Health Care, or MDHHS.

1. Resident Documentation

• Signed care agreements and assessment plans

• Up-to-date health care appraisals

• Incident/accident reports (e.g., BCAL-4607)

• Service logs and progress notes

• Emergency and evacuation plans

2. Staff Records

• Completed fingerprint/background checks (BCAL-1326A)

• CPR, First Aid, and required annual trainings

• Role-specific job descriptions and policy acknowledgments

3. Medication Records

• MARs with proper initials and administration times

• PRN documentation

• Narcotic counts and disposal logs

• Medication errors and corrective actions

4. Payroll & Wage Compliance

• Premium Pay documentation (DCW wage breakdowns)

• Timesheets and pay stubs with clear line items

• Wages that match services billed under the MI Choice Waiver

🛠️ Why Good Documentation = Peace of Mind

When your documentation is strong, you can:

• Respond to audits quickly and confidently (whether from LARA, Region VII AAA, or A&D)

• Avoid Medicaid repayment due to unsupported claims

• Prove your facility meets state and waiver standards

• Reduce staff turnover by building trust through consistency

• Improve your facility’s quality assurance and compliance scores

✅ How to Improve Your Documentation Process

1. Use Standardized Forms

Create consistent templates for:

• Monthly progress notes

• Incident reports

• Staff training records

• Resident file checklists

💡 Tip: Use digital forms when possible — they’re easier to track, organize, and retrieve during audits.

2. Schedule Monthly File Audits

Block out dedicated time each month to review:

• Resident files for missing appraisals or outdated service plans

• Staff folders for expired trainings or incomplete checklists

• Medication logs for consistency

• Payroll records for premium pay compliance

3. Train Staff on Documentation Standards

Every staff member should know how to:

• Complete progress notes clearly and objectively

• Log services in real time (especially EVV)

• Report and document incidents the same day

• Store paperwork properly (or notify when digital forms are used)

4. Connect Documentation to Billing

Every Medicaid billing claim must be supported by:

• Progress notes or time sheets

• Verified units

• Service logs aligned with the resident’s authorized care plan

Waiver agencies like A&D and Region VII AAA expect seamless alignment between what’s billed and what’s documented.

🛡️ Roseberri Can Help You Build a Compliant Documentation System

At Roseberri, LLC, we support Michigan-based AFC and waiver providers by:

• Creating compliant documentation templates and binders

• Auditing your existing records for gaps before an inspection

• Training your team to document confidently and correctly

• Aligning documentation with LARA, A&D, Region VII AAA, and MDHHS requirements

📧 roseberrimanagement@gmail.com🌐 www.roseberri.com 📍 Michigan-based | Remote services available statewide

Final Thought: Documentation = Protection

Good documentation does more than check a box. It protects your residents, your team, and your business. In a world of evolving compliance and Medicaid oversight, your records may be your first line of defense — or your biggest vulnerability.

Build a system that works — and stay ready before the next audit arrives.