New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 517 - Provider Audits
Section 517.2 - Definitions
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 517.2
Current through Register Vol. 46, No. 39, September 25, 2024
The terms defined in Part 515 of this Title have the same meanings in this Part and, in addition, as used in this Part, the following terms shall have the following meanings:
(a) Facility shall mean:
(1) any medical facility, hospital, nursing
home, residential care facility, home health agency, health maintenance
organization and diagnostic and treatment center as defined in the Public
Health Law; or
(2) any program or
facility for which the Office of Mental Retardation and Developmental
Disabilities establishes fees or rates of payment under the medical assistance
program and which is not operated by such Office.
(b) Draft audit report and final audit report refer to the formal audit reports produced by the department after on on-site review of a provider's records and denominated as such on their face, as well as to those notices sent to providers advising them of overpayments detected through in-house claims reviews or other post-payment reviews of a provider's claims.
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