Assess whether work-requirement hours are documentable (c96184)

SITUATION Compliance and Integrity Operations work in a disability unit facing a backlog of CDRs now turns on work-requirement hours are documentable because a provider billing full-time care during school hours put recoupment aging versus collectability in play. Disability continuing-eligibility reviewer should say what recoupment aging versus collectability proves.

DECISION Disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs must choose Pay or continue / Recoup / Deny / Hold using recoupment aging versus collectability after a provider billing full-time care during school hours.

HYPOTHESES TO TEST 1. Disability continuing-eligibility reviewer can defend Pay or continue from recoupment aging versus collectability after a provider billing full-time care during school hours in a Public Benefits challenge. 2. Disability continuing-eligibility reviewer cannot defend Pay or continue from recoupment aging versus collectability; Recoup is what the extract actually supports after a provider billing full-time care during school hours. 3. A provider billing full-time care during school hours never reached the population in recoupment aging versus collectability — reopen intake, do not close work-requirement hours are documentable. 4. Two facts in recoupment aging versus collectability after a provider billing full-time care during school hours conflict for disability continuing-eligibility reviewer; hold this Compliance and Integrity Operations file.

ANALYSIS REQUIRED 1. Test eligibility, recoupment, and improper-payment facts in recoupment aging versus collectability after a provider billing full-time care during school hours. 2. Quantify overpayment if work-requirement hours are documentable is wrong. 3. Separate a case-level error from a program-design failure in a disability unit facing a backlog of CDRs. 4. For this Public Benefits Compliance and Integrity Operations file, read recoupment aging versus collectability against a provider billing full-time care during school hours and write the one fact that would move work-requirement hours are documentable for disability continuing-eligibility reviewer.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (recoupment aging versus collectability after a provider billing full-time care during school hours). Lead with the Public Benefits option recoupment aging versus collectability can support after a provider billing full-time care during school hours, then the two facts that force it, then the Monday action for disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs.