Doubling costs occurs when a Plan Sponsor is reporting for the same months after the first payment request has been completed. This error occurs when there is no change in the cost data for a given month that was reported for a previous interim payment request; however, the cost data was modified to obtain the same net payment amount for a previously reported Benefit Option/month.
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Example 1 displays cost data that is being reported by Benefit Option by month. In this first payment request the Plan Sponsor is reporting cost data for the first month of the plan year, which is January 2012. Example 1 displays cost data that is being reported correctly. The cost data in the Current field is the cost data being reported by the Plan Sponsor. The Old field is blank because this is the first payment request, and no old data exists. The Net field is an RDS system calculation where the Old field is subtracted from the Current field.
Example 1: January 2012 Monthly Benefit Option Cost Summary – Correctly Reported in First Payment Request Submission
Example 2 displays cost data that is being reported by Benefit Option by month.
Costs are reported by Benefit Option by month for each cost reporting source. If there is no change to the costs previously reported for the Benefit Option/month, no update is required for the next payment request. The next cost report consists of a row of data for each set of submitted cost data for all Benefit Option/months.
This is the second payment request for the Plan Sponsor, and the Plan Sponsor is again reporting costs for January 2012 along with new costs for February 2012. In the first payment request (Example 1) the Plan Sponsor requested $25,158.00 of subsidy. This is the same amount listed in the Old field in Example 2 for January 2012. In this second payment request, the Plan Sponsor has no additional cost to report for January 2012 because there was no change in the cost data from the first payment request to the second payment request. Instead of reentering the same amount that was previously reported for January 2012 in the first payment request in the Current field, the Plan Sponsor incorrectly doubled the cost so that the Net field reflected the cost that was previously entered. This error led to the subsidy being doubled to $50,316.00 instead of $25,158.00 for January 2012.
Example 2: January and February 2012 Monthly Benefit Option Cost Summary – Incorrectly Reported in Second Payment Request Submission
Example 3 displays cost data that is being reported by Benefit Option by month. The example displays the correct way to report cost.
This is the second payment request with costs being reported for the months of January and February 2012. This example displays the correct way to report costs when there is no change to the cost data for January 2012. The Old field for January 2012 contains the cost data that was entered in the first payment request. In the Old field for January 2012 in Example 3, the cost data resulted in a subsidy of $25,158.00.
The same amounts that were previously entered in the Old field are reentered in the Current field for January 2012 in this second payment request because there is no change in the cost data from the first payment request to the second payment request for the month of January 2012. The Cost Reporter is supposed to report actual costs incurred for the Benefit Option during the month. The RDS system performs the NET calculation by subtracting the Old field from the Current field. The Net field in Example 3 for January 2012 appropriately displays zeros for all the cost factors, which means there is no change in the cost data that was previously entered in the prior payment request. The net zero dollars sometimes causes confusion because a Plan Sponsor thinks it is reporting zero costs for the month. However, it is the correct way to report cost data when there is no change in the data.
Example 3: January and February 2012 Monthly Benefit Option Cost Summary – Correctly Reported in Second Payment Request Submission