048-24 Wyo. Code R. §§ 24-12 - Audits
(a) Field audits. The Department or HCFA may
perform a field audit of a provider at any time to determine the accuracy and
reasonableness of cost reports, the accuracy of cost settlements or whether the
hospital has received excess payments.
(b) Desk review. The Department or HCFA may
perform a desk review of a provider at any time to determine the accuracy and
reasonableness of cost reports, the accuracy of cost settlements or whether the
hospital has received excess payments.
(c) The Department or HCFA may perform field
audits or desk reviews through employees, agents, or through a third party.
Audits shall be performed in accordance with GAAS.
(d) Disallowances. If a field audit or desk
review discloses nonallowable costs, overpayments or excess payments, the
Department shall adjust the final cost settlement and recover any excess
payments pursuant to Section
14.
(e) Notice of excess payments.
After determining that a provider has received excess payments, the Department
shall send written notice to the provider, by certified mail, return receipt
requested, stating the amount of the excess payments, the basis for the
determination of excess payments and the providers right to request
reconsideration of that determination pursuant to Section
17.
The reconsideration shall be limited to whether the Department has complied
with the provisions of this rule.
(f) Recovery of excess payments. A provider
must reimburse the Department for excess payments within fifteen days after the
provider receives written notice from the Department pursuant to subsection
(e), even if the provider has requested reconsideration or an administrative
hearing regarding the determination of excess payments. If the provider fails
to timely repay excess payments, the Department may recover the excess payments
pursuant to Sections
14.
Notes
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