Frequently Asked Questions (FAQ) About PERM

Payment Error Rate Measurement (PERM) Frequently asked questions (FAQ) about PERM

What is PERM?  Promotes efficient Medicaid and CHIP The federal Payment Error Rate Measurement program operations. (PERM) program is administered by the Centers for  Helps to ensure medical services are Medicare and Medicaid Services (CMS) through provided to the truly eligible. federal contractors, and measures improper payments in Medicaid and the Children’s Health How often are states measured under PERM? Insurance Program (CHIP). Individual state error PERM reviews each state once every three years, rates are measured for each program, and are then rotating between three cycles, or groups, of 17 states. combined to form a national error rate which is Washington is part of Cycle 3 and was measured reported to Congress. Error rates are based on during Federal Fiscal Year 2008, 2011, 2014 and will reviews of eligibility determinations, and fee-for- be measured for FFY 2017. This means that all claims service (FFS) and managed care payments made for paid during the period of October 1, 2016 through Medicaid and CHIP claims during the Federal fiscal September 30, 2017 for both FFS and managed care year (FFY) under review. clients are part of the universe of payments from which an audit sample is drawn. Why was the PERM program created? PERM was developed by CMS to comply with the How will I know if a claim I submitted is Improper Payments Information Act (IPIA) of 2002, selected for review? which was amended by the Improper Payments Any claim that is paid between October 1, 2016 and Elimination and Recovery Act (IPERA) in July 2010. September 30, 2017 with Medicaid or CHIP funding These Acts require the heads of Federal agencies, will be part of the payment universe. A sample of including the Department of Health and Human claims will be randomly drawn from each quarter, Services (HHS), to annually review their programs and these will be the claims reviewed by the federal and identify those which may be susceptible to contractor. If a claim you submitted is selected to be significant improper payments. The amount of part of the PERM measurement during this cycle, you improper payments is required to be estimated and will be notified prior to receiving contact from the those estimates are submitted to Congress, along contractor. with a report on actions the agency is taking to I am not a “medical” provider-does PERM reduce the improper payments. Medicaid and CHIP were identified as programs at risk for significant still apply to me? improper payments. Therefore, HHS must report the Payments made to a wide variety of provider types estimated error rates for the Medicaid and CHIP contain funding from Medicaid and CHIP dollars. In programs each year for inclusion in the Performance addition to payments made to physicians, hospitals, and Accountability Report (PAR). CMS implemented nursing facilities and managed care plans, payments the PERM program in a Final Rule published on made to other types of providers could be in the August 31, 2007 (72 FR 50490) and made revisions PERM universe. These include: in a Final Rule published August 11, 2010 (75 FR  In-home care and support services provided 48816). by an individual provider What are the benefits of the PERM program?  Private duty nursing The PERM program:  Pharmacy claims  Identifies program vulnerabilities that result in improper payments.  Dental claims  Residential and supported living services

Medicaid Program Operations and Integrity, Section of Program Integrity – PERM 07/13/2017 1  Non-emergency transportation services CMS has posted information about PERM on its website. On the link provided, under the ‘Downloads’ Who will contact me to ask for my records? section, there is additional information about the All providers with claims selected to be in the PERM PERM review process. This includes an overview of sample for FFY 2017 will receive an initial phone call PERM to help providers understand what may be followed by a letter from the CMS Review Contractor, required during a PERM review. Please check back CNI Advantage, LLC. This letter will have the CMS often for updates and bookmark this page for your logo across the top. Please do not ignore this letter. reference. If you have questions, please contact the HCA staff person listed in the letter form us or email Laws and regulations: [email protected].  Final Rule (August 2010) How much time will I have to provide  Major Changes Summary-Final Rule (August records? 2010) CNI Advantage, LLC will ask you for a fax number. It  Proposed Rule (July 2009) will help the record request process go faster if they can fax you their information. By statute, providers  Final Rule (August 2007) have 75 days to submit records for review to the  Second Interim Final Rule (August 2006) PERM contractor. However, this is the latest due date, and it is more helpful to send your records at your  Interim Final Rule (October 2005) earliest convenience in case there are additional  Proposed Rule (August 2004) questions about your documentation. Legal authority regarding PERM: Do I really need to send in documentation? Yes. Providers are required to keep records  Section 1902 (a)(27) of the Social Security associated with payments received from Medicaid or Act CHIP programs for six (6) years. Under the authority  Health Insurance Portability and of section 1902(a)(27) of the Social Security Act, Accountability Act (HIPAA) of 1996 providers are required to retain records necessary to disclose the extent of services provided to individuals  42 CFR parts 431 and 447 receiving assistance, and providers must furnish CMS  45 CFR parts 160 and 164 and the State Medicaid Agency with information regarding any payments claimed by the provider for  Revised Code of Washington (RCW) furnishing services. 74.09.200 Even though some claims may be for small dollar  Washington Administrative Code (WAC) 182- amounts, because of the way these payments are 502a divided in the claims sample, even small payments  Core Provider Agreement could have a big impact on a state’s error rate if the claim was found to be paid in error. Please do your Who can I contact at HCA for more part to help ensure the measurement’s success by information? locating and submitting your documentation as You can email [email protected] for more quickly as possible after your receive the request. information. For more information:

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