Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 70 - METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES - INPATIENT HOSPITAL SERVICES › Part V - Inpatient Hospital Payment System › Article 3 - Other Provisions for Payment of Inpatient Hospital Services › Section 12VAC30-70-480 - Refund of overpayments

Current through Register Vol. 40, No. 24, July 15, 2024
A. Lump
					 sum payment. When the settlement of a hospital fiscal year indicates that an
					 overpayment has occurred, full refund shall be remitted with the cost report.
					 In cases where the state agency discovers an overpayment during desk review,
					 field audit, or final settlement, the state agency shall promptly send the
					 first demand letter requesting a lump sum refund. Recovery shall be undertaken
					 unless the hospital disputes the state agency's determination of the
					 overpayment. If the hospital disputes the state agency "s determination,
					 recovery, if any, shall be undertaken after the issue date of any
					 administrative decision issued by the state agency after an informal fact
					 finding conference.
B. Offset. If
					 the hospital has been overpaid for a particular fiscal year and has been
					 underpaid for another fiscal year, the underpayment shall be offset against the
					 overpayment. So long as the hospital has an overpayment balance, any
					 underpayments discovered by subsequent review or audit shall also be used to
					 reduce the remaining amount of the overpayment.
C. Payment schedule. If the hospital cannot
					 refund the total amount of the overpayment (i) at the time it files a cost
					 report indicating that an overpayment has occurred, the hospital shall request
					 an extended repayment schedule at the time of filing or (ii) within 30 days
					 after receiving the DMAS demand letter, the hospital shall promptly request an
					 extended repayment schedule.
DMAS may establish a repayment schedule of up to 12
						months to recover all or part of an overpayment or, if a hospital demonstrates
						that repayment within a 12-month period would create severe financial hardship,
						the Director of the Department of Medical Assistance Services (the director)
						may approve a repayment schedule of up to 36 months.
A hospital shall have no more than one extended
						repayment schedule in place at one time. If an audit later uncovers an
						additional overpayment, the full amount shall be repaid within 30 days unless
						the hospital submits further documentation supporting a modification to the
						existing extended repayment schedule to include the additional amount.
If, during the time an extended repayment schedule is in
						effect, the hospital withdraws from the program or fails to file a cost report
						in a timely manner, the outstanding balance shall become immediately due and
						payable.
When a repayment schedule is used to recover only part
						of an overpayment, the remaining amount shall be recovered by the reduction of
						interim payments to the hospital or by lump sum payments.
D. Extension request documentation. In the
					 request for an extended repayment schedule, the hospital shall document the
					 need for an extended (beyond 30 days) repayment and submit a written proposal
					 scheduling the dates and amounts of repayments. If DMAS approves the schedule,
					 DMAS shall send the hospital written notification of the approved repayment
					 schedule, which shall be effective retroactive to the date the hospital
					 submitted the proposal.
E. Interest
					 charge on extended repayment. Interest charges on the unpaid balance of any
					 overpayment shall accrue pursuant to § 32.1-313 of the Code of Virginia
					 from the date the director's determination becomes final.
The director's determination shall be deemed to be final
						on (i) the due date of any cost report filed by the hospital indicating that an
						overpayment has occurred, or (ii) the issue date of any notice of overpayment,
						issued by DMAS, if the hospital does not file an appeal, or (iii) the issue
						date of any administrative decision issued by DMAS after an informal fact
						finding conference, regardless of whether the hospital files a further appeal.
						In any event, interest shall be waived if the overpayment is completely
						liquidated within 30 days of the date of the final determination. In cases in
						which a determination of overpayment has been judicially reversed, the hospital
						shall be reimbursed that portion of the payment to which it is entitled, plus
						any applicable interest which the hospital paid to DMAS.
Statutory Authority
§ 32.1-325 of the Code of Virginia and Item 322 J
						  of Chapter 912 of the 1996 Virginia Acts of Assembly.