Plain English Breakdown
The official source material does not specify the exact consequences if the error rate is less than 2.75%.
Medicaid Provider Audit Rules
This act changes how audits are done for pharmacies in the Medicaid program, limiting when auditors can use a method called 'extrapolation' and requiring educational materials before audits.
What This Bill Does
- Changes rules about finding mistakes in payments to pharmacies in the Medicaid program.
- Limits when auditors can use extrapolation to find overpayments or underpayments unless they exceed 2.75% of total claims paid to the pharmacy for the audit period.
- Requires the commissioner to provide educational materials and technical assistance documents to assist providers with proper Medicaid billing before audits.
Who It Names or Affects
- Pharmacies that receive payments through Medicaid.
- The department responsible for administering Medicaid programs.
Terms To Know
- extrapolation
- A method used to estimate the total amount of overpayment or underpayment based on a sample of claims.
- audit period
- The time frame during which an audit is conducted for Medicaid payments.
Limits and Unknowns
- Does not specify what happens if the error rate is less than 2.75%.
- It does not provide details on how educational materials and technical assistance will be delivered to pharmacies.