Ala. Admin. Code r. 560-X-42-.23

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-42-.23 - Audit Adjustment Procedures

(1) Audit adjustments will be paid or collected by a combination of

(a) changing the per diem rate of the facility and

(b) a lump sum settlement for the amount under/overpaid for the period prior to the effective date of the per diem rate change.

(2) Under/Overpayment situations arising from the audit of a terminating cost report will be paid or recouped by a lump sum settlement.

(3) All adjustments will be subject to the limitations set out in this chapter and subject to the appropriate ceilings.

(4) Collection procedures will be applied only after the facility has been given thirty (30) days in which to disagree with any of the disallowances contained in the report of audit.

(5) A copy of the report of audit will be forwarded to the Reimbursement and Rate Analysis Section when the report of audit is mailed to the facility. After the thirty (30) day notification period is up and no request for an informal conference has been received, a new per diem rate will be calculated based on audit adjustments in the report of audit. The new per diem rate will be effective for billing purposes on the 1st day of the following month. A final audit computation sheet will be prepared. The audit settlement will be collected or paid in a lump sum amount. This lump sum amount for the months prior to the effective date of the rate change is computed by applying the adjustment per resident day to the total Medicaid days in the overpayment/underpayment period.

Author: Susan Mims

Ala. Admin. Code r. 560-X-42-.23

Rule effective October 13, 1988. Amended: Filed: June 8, 1993; effective July 13, 1993.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§447.250 - .255.