Sec. 10.09.10.22. Desk Reviews and Field Verification

A. Desk Reviews.

(1) The Department or its designee may conduct a desk review of the costs before establishing the Administrative and Routine and Other Patient Care prices and Nursing Service rates.

(2) The Department or its designee shall notify each provider participating in the Program if any adjustments resulted from the desk review.

(3) Desk review adjustments shall be used in the computation of any future rate for the facility or the facility’s future owner that is based on the reported or desk reviewed costs, until the rate is rebased.

B. Field Verifications.

(1) The Department or its designee may conduct a field verification of the reported or desk reviewed costs affecting reimbursement rates.

(2) The Department or its designee shall notify each provider participating in the Program of the results of the field verification.

(3) Field audit adjustments shall be used in the computation of any future rate for the facility or the facility’s future owner that is based on the reported or desk reviewed costs, until the rate is rebased.

(4) Field audit adjustments shall be used in the recomputation of any past rate for the facility or the facility’s past owner that is based on the reported or desk reviewed costs.

(5) If the recomputation of rates results in a rate that differs more than 2 percent from the initial rate computation excluding the quality assessment, the Department shall initiate an adjustment for the impacted service dates within 60 days after the notification described in §B(2) of this regulation.

(6) Field audit adjustments shall only affect the facility’s rates and do not affect prices or rates for other facilities within the geographic region.