Effective for dates of service on or after January 1, 2003, the Arkansas Medicaid Program implemented retrospective reviews of occupational therapy, physical therapy, and speech-language pathology (Director’s Memo IA-03-043). The Arkansas Foundation for Medical Care (AFMC) conducts retrospective reviews based on a random sampling of all therapy claims. Medicaid has issued an Official Notice reminding all providers of these services (including enrolled school districts and co-ops) that recoupments will be made beginning in May 2004 based on the retrospective reviews.
The recoupment of funds is an overpayment of claims denied for not meeting medical necessity requirements. Medicaid will be sending providers of these services an Explanation of Recoupment Notice. This will include the claim date of service, Medicaid recipient, service provided, amount paid by Medicaid, amount to be recouped and the reason the claim has been denied. A peer review process is available for claims that providers feel have met the requirements. A repayment plan will be established specific to the needs of the provider. For more information regarding this issue, please follow the Provider/Official Notices link for OT, PT, SLP services at www.medicaid.ar.us for the complete text of this notice, dated April 22,2004.
Contact Tony Boaz as shown above if further clarification is necessary.