Browse Arkansas Code titles and sections
20-77-1703. Recoupment.
Arkansas Code — all titles (historical 2020) · legal_authorities
20-77-1703. Recoupment.
(a)(1) The Department of Human Services shall not use a technical deficiency as grounds for recoupment unless identifying the technical deficiency as an overpayment is mandated by a specific federal statute or regulation or the state is required to repay the funds to the Centers for Medicare & Medicaid Services, or both.
(2) When recoupment is permitted, the department shall not recoup until there is a final determination identifying the funds to be recouped as overpayments.
(b)(1) The department shall recognize that an error or omission is a technical deficiency if:
(A) The error or omission meets the definition of “technical deficiency” in § 20-77-1702;
(B) The error or omission involved a covered service; and
(C) The provider can substantiate through other documentation that the medical assistance was provided.
(2) Other documentation under subdivision (b)(1)(C) of this section shall be:
(A) In accord with generally accepted healthcare practices; and
(B) Contemporaneously created.
(3) Other documentation under subdivision (b)(1)(C) of this section is not required to be equivalent in form to, nor required to duplicate, the documentation containing the error or omission, if all the documentation taken together establishes that the claim is payable.
(c) This section does not preclude a corrective action plan or other nonmonetary measure in response to technical deficiencies.
(d)(1) If a provider fails to comply with a corrective action plan for a pattern of technical deficiencies, then appropriate monetary penalties may be imposed if permitted by law.
(2) However, the department first must be clear as to what the technical deficiencies are by providing clear communication in writing or a promulgated rule when required.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 20-77-1703
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Stable record: arkansas_code:legal_authorities:20-77-1703
Source file: gov.ar.code.title.20.odt
Pages: Not recorded – Not recorded
Passage SHA-256: af2e2b4e553f5d5a2991806044ec5461e45e5c3a7be85134bc5a81112a9c2144
Source location: content.xml paragraph 37418
Stored source content
20-77-1703. Recoupment.
(a)(1) The Department of Human Services shall not use a technical deficiency as grounds for recoupment unless identifying the technical deficiency as an overpayment is mandated by a specific federal statute or regulation or the state is required to repay the funds to the Centers for Medicare & Medicaid Services, or both.
(2) When recoupment is permitted, the department shall not recoup until there is a final determination identifying the funds to be recouped as overpayments.
(b)(1) The department shall recognize that an error or omission is a technical deficiency if:
(A) The error or omission meets the definition of “technical deficiency” in § 20-77-1702;
(B) The error or omission involved a covered service; and
(C) The provider can substantiate through other documentation that the medical assistance was provided.
(2) Other documentation under subdivision (b)(1)(C) of this section shall be:
(A) In accord with generally accepted healthcare practices; and
(B) Contemporaneously created.
(3) Other documentation under subdivision (b)(1)(C) of this section is not required to be equivalent in form to, nor required to duplicate, the documentation containing the error or omission, if all the documentation taken together establishes that the claim is payable.
(c) This section does not preclude a corrective action plan or other nonmonetary measure in response to technical deficiencies.
(d)(1) If a provider fails to comply with a corrective action plan for a pattern of technical deficiencies, then appropriate monetary penalties may be imposed if permitted by law.
(2) However, the department first must be clear as to what the technical deficiencies are by providing clear communication in writing or a promulgated rule when required.
(e) The department shall not issue a recoupment on a minor omission such as a missing date or signature if the requirements of this section are met.
(f) The department shall not rely on the denial of one claim as the sole basis for the denial of a subsequent claim and shall establish that the subsequent claim is deficient.
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Arkansas Code — all titles (historical 2020) · legal_authorities
20-77-1702. Definitions.
As used in this subchapter:
(1) “Abuse” means a pattern of provider conduct that is inconsistent with sound fiscal, business, or medical practices and that results in:
(A) An unnecessary cost to the Arkansas Medicaid Program; or
(B) Reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care;
(2)(A) “Adverse decision” means any decision by the Department of Human Services or its reviewers or contractors that adversely affects a Medicaid provider or recipient in regard to:
(i) Receipt of and payment for Medicaid claims and services, including, but not limited to, decisions as to:
(a) Appropriate level of care or coding;
(b) Medical necessity;
(c) Prior authorization;
(d) Concurrent reviews;
(e) Retrospective reviews;
(f) Least restrictive setting;
(g) Desk audits;
(h) Field audits and onsite audits; and
(i) Inspections or surveys; and
(ii) Payment amounts due to or from a particular provider resulting from gain sharing, risk sharing, incentive payments, or another reimbursement mechanism or methodology, including calculations that affect or have the potential to affect payment.
(B) To constitute an adverse decision, an agency decision need not have a monetary penalty attached but must have a direct monetary consequence to the provider.
(C) “Adverse decision” does not include the design of or changes to an element of a reimbursement methodology or payment system that is of general applicability and implemented through the rulemaking process;
(3) “Appeal” means an appeal of an adverse decision to an independent administrative law judge as provided under this subchapter;
(4) “Claim” means a request for payment of services or for prior, con
Source: Arkansas Code — historical release 78 (November 6, 2020) · 20-77-1702
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 20-77-1702. This identifies an authority to review, not proof of applicability.