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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
APPENDIX H
AGREED-UPON PROCEDURES FOR
FEE-FOR-SERVICE PROGRAMS
I.
These procedures are to be performed for the period July 1, 2010 – June 30, 2011,
regardless of the provider’s actual fiscal year-end.
Level I Procedures:
II.
Units of Service
1. Obtain a list of all fee-for-service claims paid by the Pennsylvania Department of
Public Welfare (DPW) and/or the counties/Administrative Entities from the Provider
during the period of these procedures.
2. Reconcile the Provider’s list of paid claims to the Provider’s cash receipts journal and
note any reconciling items and/or differences.
3. Select a random sample of 60 of the paid claims described in Procedure II,1, above.
4. For each of the sample of paid claims described in Procedure II,3, above:
a. Obtain supporting documentation from the Provider.
b. Inspect the supporting documentation described in Procedure II,4,a, above, as
follows:
1. Verify that the supporting documentation includes evidence that the services
were authorized. Include in the report a description of the Provider’s
methodology of documenting this authorization.
i. If there are 2 or more exceptions noted in the sample of 60 that indicate
that the services were not authorized, proceed to Level II Procedures,
below.
2. Verify that the supporting documentation includes evidence that the services
were provided. Include in the report a description of the Provider’s
methodology of documenting this existence/occurrence.
i. If there are 2 or more exceptions noted in the sample of 60 that indicate
that the services were not provided, proceed to Level II Procedures, below.
III.
Cost Allocation Plan:
1. Inquire if the Provider has a written cost allocation plan. If so, obtain the Provider’s
cost allocation plan and include a copy in the report. If not, obtain an understanding
of the Provider’s cost allocation plan, document that understanding, and include that
documentation in the report.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
APPENDIX H
AGREED-UPON PROCEDURES FOR
FEE-FOR-SERVICE PROGRAMS
IV.
Direct and Indirect/Administrative Costs:
1. Select a random sample of 60 cash disbursements from a Provider-prepared list. This
list should include both direct and indirect/administrative costs.
2. Vouch each of the 60 cash disbursements described in Procedure IV,1, above, to
supporting documentation (invoices, etc.) and verify that the date paid, amount, and
description included in the Provider-prepared list of disbursements agrees to the
supporting documentation.
a. If there are 2 or more exceptions noted in the sample of 60 that indicate a problem
with the records not agreeing to the supporting documentation, proceed to Level
II Procedures, below.
3. For any indirect/administrative costs included in the sample described in Procedure
IV, 2 above, verify that each of these costs are allocated in accordance with the cost
allocation plan. Note the total number of indirect/administrative costs tested and the
number of exceptions.
a. If there are 2 or more exceptions noted in the sample of 60 that indicate a problem
with costs are not allocated in accordance with the cost allocation plan, proceed to
Level II Procedures, below.
V.
Cost of Services Provided:
1.
2.
3.
4.
5.
Obtain a schedule from the Provider of the total costs incurred for each service
code that was paid by DPW and/or the counties / Administrative Entities during
the period of these procedures. This schedule should also include the total units
provided for each service code. In addition, this schedule should include the rates
paid to the Provider for each service code.
Compare the total units of service for each service code provided, as obtained in
Procedure V,1, above to the list obtained from the Provider in Procedure II,1,
above and note any differences.
Obtain the data used to prepare the schedule in Procedure V,1, above, and trace
each of the 60 cash disbursements described in Procedure IV,2, above, to this data
and verify that these costs are included and that indirect/administrative costs are
charged in accordance with the Provider’s cost allocation plan, described in
Procedure III,1, above.
Include in the report a copy of the schedule obtained in Procedure V,1, above.
Calculate the excess (deficiency) of each rate over costs for each service code,
both in terms of dollars per unit and a percentage. Included these calculations in
the report.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
APPENDIX H
AGREED-UPON PROCEDURES FOR
FEE-FOR-SERVICE PROGRAMS
VI.
Other:
1.
Include in the report any other information that comes to the attention of the
accountant, in accordance with the American Institute of Certified Public
Accountants’ Statements on Standards for Attestation Engagements Section 201,
Agreed-Upon Procedures Engagements (AT§201.40).
Level II Procedures:
PLEASE NOTE THAT LEVEL II PROCEDURES ARE TO BE PERFORMED ONLY IF
REFERRED TO IN LEVEL I PROCEDURE II 4 b 1 i, II 4 b 2 i, IV 2 a, OR IV 3 a, ABOVE,
AND THEN ONLY AFTER DISCUSSING WITH AND OBTAINING PRIOR APPROVAL
FROM DPW TO PROCEED TO LEVEL II.
I.
Units of Service
1. Select a statistically valid random sample based on a 90% Confidence Level of the
paid claims described in Level I, Procedure II,1, above.
a. Obtain supporting documentation from the Provider.
b. Inspect the supporting documentation described in Level II, Procedure I,1,a,
above, as follows:
1. Verify that the supporting documentation includes evidence that the services
were authorized.
2. Project any exceptions to the population
3. Verify that the supporting documentation includes evidence that the services
were provided. Include in the report a description of the Provider’s
methodology of documenting this existence/occurrence.
4. Project any exceptions to the population
II.
Direct and Indirect/Administrative Costs:
1. Select a statistically valid random sample based on a 90% Confidence Level of the
cash disbursements described in Level I, Procedure IV, 1, above.
2. Vouch each of the cash disbursements described in Level II, Procedure II,1, above, to
supporting documentation (invoices, etc.) and verify that the date paid, amount, and
description included in the Provider-prepared list of disbursements agrees to the
supporting documentation.
3. Project any exceptions to the population
4. For any indirect/administrative costs included in the sample described in Level II,
Procedure II, 2 above, verify that each of these costs are allocated in accordance with
the cost allocation plan. Note the total number of indirect/administrative costs tested
and the number of exceptions.
5. Project any exceptions to the population
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