Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-502A - Program integrity
Section 182-502A-0501 - Entity self-audits
Universal Citation: WA Admin Code 182-502A-0501
Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid agency may require an entity to self-audit.
(a) The agency gives written notice of the
instruction to self-audit.
(b) The
entity must acknowledge receipt of the notice within thirty calendar days of
receiving it.
(c) The entity must
comply with all terms included in the notice; failure to timely comply with the
notice constitutes failure to comply with a program integrity
activity.
(d) The agency does not
require an entity to self-audit any services or encounters that are included in
an active state or federal program integrity activity, rate adjustment, cost
settlement, or other payment adjustment.
(e) The agency reviews the self-audit and
states in writing whether it accepts or rejects the results of the self-audit.
If the agency rejects the results it may:
(i)
Instruct the entity to repeat the self-audit; or
(ii) Audit the entity.
(2) When an entity self-discloses overpayments, it must:
(a) Submit to the
agency written notice of the self-audit and identify each claim included in the
self-audit.
(b) Report and repay
the overpayment to the agency within sixty calendar days of identifying the
overpayment, unless the overpayment is:
(i)
Included in an active state or federal program integrity activity; or
(ii) Related to a state-initiated rate
adjustment, cost settlement, or other payment adjustment.
(c) The entity's overpayment report must
include:
(i) The reason for the
overpayment;
(ii) How the entity
calculated the overpayment; and
(iii) A list of claims associated with the
overpayment.
(d) The
agency reviews the self-audit and states in writing whether it accepts or
rejects the methodology and findings. If the agency rejects the findings it
may:
(i) Instruct the entity to repeat the
self-audit; or
(ii) Audit the
entity.
(e) The agency
does not accept any identified overpayment as full or final repayment before
the completion of its review of the entity's self-audit findings.
(3) The entity's dispute and appeal rights under this section are identical to its rights during an audit conducted by the office of program integrity.
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