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(3) “field audit” means an audit of a provider conducted by the department or its designee based upon an examination of a provider’s records with at least one on-site visit to conduct audit procedures at the provider’s place of business or site where the provider maintains business records. (Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199; am 6/7/2018, Register 226) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 AS 47.07.074
AS 47.05.200 AS 47.07.040 7 AAC 160.115. Duty of a provider to identify and repay self-identified overpayments. (a) An enrolled provider who bills the department for services rendered during a calendar year shall conduct, once every two years, a review or audit of a statistically valid random sample of claims submitted to the department for reimbursement, unless the provider is being audited under AS 47.05.200(a). The universe of claims from which the random sample is drawn must be all claims that are billed with dates of service during the calendar year for the provider and that may be identified at the taxpayer identification level. As part of the self-review or self-audit, a provider shall establish appropriate corrective actions for any deficiencies identified. (b) A biennial review or audit conducted under this section shall be conducted not earlier than one year following the end of the calendar year to allow for timely filing of all claims. (c) The provider may use any widely accepted statistical software, such as RAT-STATS, developed by the United States Department of Health and Human Services, Office of Inspector General, to assist in sample size determination, and sample selection, using a minimum of a 90-percent confidence interval. (d) If a provider identifies overpayments through the biennial review or audit, the provider shall report each overpayment to the department not later than 10 business days after identification of that overpayment. Overpayment reports shall be submitted to the Department of Health, Office of the Commissioner, Medicaid Program Integrity. In this subsection, “business day” means a day other than Saturday, Sunday, or a legal holiday under AS 44.12.010. (e) A provider who was reimbursed
(1) $30,000 or greater for services during the year shall submit a report to the department detailing the claims audited or reviewed together with the results of that review or audit;