Corporate Compliance

GOV’T AUDIT INSIDER: Missing documentation in Colorado

Healthcare Auditing Weekly, November 9, 2004

Missing documentation in Colorado

The OIG was unable to determine whether Colorado's 2003 Medicaid enhanced payment was correct because Colorado could not locate documentation verifying the initial Medicare base rates used for calculating the inpatient hospital rate. The OIG review showed that Colorado did follow federal and state laws for calculating upper payment limit (UPL) payments. The OIG says Colorado should keep all needed documentation for a minimum of four years. During the audit, the OIG did the following:

  • Selected a sample of providers from each of Colorado's state plan amendments and followed the UPL calculation from the source through the state's formula to the actual payment

  • Obtained and reviewed the support for UPL payments through interviews and documentation

  • Analyzed Colorado's UPL calculations for inpatient hospitals, outpatient hospitals, and nursing facilities

    Click here to read the audit report, "Review of Colorado Upper Payment Limit Requirements for Colorado," (A-07-03-02673), issued October 5.

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