Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-502A - Program integrity
Section 182-502A-0601 - Extrapolation
Universal Citation: WA Admin Code 182-502A-0601
Current through Register Vol. 24-18, September 15, 2024
(1) To determine an improper payment from a sample, the medicaid agency may extrapolate to the universe from which the sample was drawn:
(a)
If the audit identifies a sustained high level of payment error involving the
provider; or
(b) When the agency
has documented educational intervention to the provider and the education has
failed to correct the provider's level of payment error.
(2) If during the course of the audit, an entity adjusts or rebills a claim or encounter that is part of the audit sample or universe, the original claim or encounter amount remains in the audit sample or universe.
(3) When the agency uses the results of an audit sample to extrapolate the amount to be recovered, the agency provides the entity with the following information:
(a) The sample size.
(b) The method used to select the
sample.
(c) The universe from which
the sample was drawn.
(d) Any
formulas or calculations used to determine the amount of the improper
payment.
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