Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 105 - Medicaid Provider and Recipient Participation
Article 2 - Provider Enrollment, Rights, and Responsibilities
7 AAC 105.260 - Recouping an overpayment
Universal Citation: 7 AK Admin Code 105.260
Current through November 28, 2024
(a) An overpayment occurs when the department pays a provider
(1) for a service without prior authorization
when prior authorization is required under 7 AAC 105 - 7 AAC 160;
(2) an amount that exceeds the maximum
dollars or units allowed under 7 AAC 105 - 7 AAC 160;
(3) for a service not covered under 7 AAC 105
- 7 AAC 160;
(4) for a service not
authorized under the provider's current provider agreement;
(5) for a service paid for by another source,
or a service eligible for payment by another source;
(6) in an amount the provider or the
department identifies as an overpayment;
(7) in excess of the amount due because of an
error or omission of an automated claims processing system;
(8) incorrectly for services that do not meet
standards established for payment of services;
(9) who is not an enrolled Medicaid
provider;
(10) for a service
already paid by the department;
(11) for a service provided to a recipient
ineligible for Medicaid under AS 47.07 and 7 AAC 100;
(12) for a service provided to a recipient
eligible for Medicaid under AS 47.07 and 7 AAC 100, but ineligible for the
service billed to the department;
(13) in excess of the amount due because of
the billing practices of the provider; or
(14) for a service that was not
rendered.
(b) The department may
(1) recoup an overpayment from
a provider, without notice to the provider other than as provided by (c) of
this section, by reducing future payments to the provider until the overpaid
amount has been offset; or
(2)
arrange with the provider the terms of the provider's repayment of the
overpayment.
(c) Before the department
(1) recoups an overpayment
more than 120 days after the date of the overpayment under (b)(1) of this
section, the department will notify the provider in writing at least 60 days
before recoupment of the overpayment begins; or
(2) recoups an overpayment under (b)(2) of
this section, the department will notify the provider in writing at least 60
days before recoupment of the overpayment begins.
(d) In the notice under (c) of this section, the department will include
(1) the reason
for the recoupment;
(2) the amount
of the overpayment that the department will recoup; and
(3) notice of the provider's right to an
appeal under
7
AAC 105.270.
(e) If, following receipt of a notice under (c) of this section, the provider discontinues billing the department for Medicaid services, the department will send a written demand to the provider for repayment of the balance of the overpayment.
(f) This section does not apply to
(1) actions under
7
AAC 105.400 -
7
AAC 105.490, or bankrupt or out-of-business
providers;
(2) recoupment that is
based solely on a prospective payment rate under 7 AAC 150;
(3) recoupment actions identified in an audit
under 7 AAC 160.100 -
7
AAC 160.130.
(4) recoupment actions identified in an
independent certified audit under
7
AAC 150.180(l) with respect to a
hospital receiving payments as a disproportionate share hospital
(DSH).
Authority:AS 47.05.010
AS 47.05.200
AS 47.07.030
AS 47.07.040
Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
