Payment Error Rate Measurement

Payment Error Rate Measurement Program (PERM)

PERM was developed to comply with the Improper Payments Information Act (IPIA; Public Law 107-300) of 2002 which requires each federal agency to:

  1. Annually identify programs that may be susceptible to significant and improper payments.
  2. Estimate the amount of improper payments.
  3. Submit the estimated amounts to Congress.
  4. Submit a report on actions the agency is taking to reduce the improper payments.

PERM is administered by the Department of Health & Human Services (HHS) by the Centers for Medicare & Medicaid Services (CMS) with guidance from various oversight bodies including the Office of Management and Budget (OMB), and the Office of the Inspector General (OIG).

Under PERM , reviews will be conducted in three areas: (1) fee for service claims (FFS); (2) managed care claims; and (3) program eligibility. The fee for service claims review component also includes a medical review.

The program uses a national contracting strategy to conduct the fee for service and managed care claims review components. This strategy utilizes the following contractors:

  1. The Lewin Group - Statistical Contractor (SC).
  2. AdvanceMed – Review Contractor (RC).
  3. Booz Allen Hamilton - Eligibility Contractor (EC)
The Medical Review Process

CMS has contracted with AdvanceMed to be their Review Contractor (RC). They will request documentation from a sample of providers to substantiate claims paid in the review period of July 1, 2019 - June 30, 2020. The provider will have 75 days to provide the required medical documentation to the Review Contractor. If the medical documentation is not received, an error will be assessed.

AdvanceMed will then perform a medical review of the sampled claim to determine if the claim was correctly paid or denied according to policy.

The New York State Office of the Medicaid Inspector General (OMIG) is requiring that the provider send a duplicate copy of the documentation to us in order to confirm that it is complete. This is necessary to alleviate errors where the contractor does not receive the medical records (or receives incomplete medical records). This circumstance has occurred in prior cycles and the OMIG is committed to reducing these occurrences.

Authority

The New York State Office of the Medicaid Inspector General has the authority to collect medical documentation under the New York Public Health Law Section 32, Subsections 9 and 10, as well as under Regulations 18 NYCRR 515.2(b)(6) and 515.3. Additionally, Federal, State and HIPAA statutes and regulations require the provision of such information upon request, without patient consent (see the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Privacy Rule Regulations at 45 CFR Parts 160 and 164).

Provider Role
  1. To provide complete and accurate medical records to AdvanceMed as quickly as possible.
  2. To provide a duplicate medical record to OMIG staff.
  3. To respond promptly to inquiries regarding medical documentation from AdvanceMed and OMIG
OMIG Role
  1. To assist AdvanceMed in obtaining accurate and complete medical documentation.
  2. To request a duplicate medical record be sent to OMIG staff.
  3. To review the medical documentation that supports the claim payment for accuracy and completeness.
  4. To appeal findings in the Dispute Resolution Process with the review contractor.
  5. To appeal findings upheld in the Dispute Resolution Process with CMS.
  6. To collect any overpayments.

 

Additional information regarding PERM is available via the related links section on this page. Providers may refer any additional questions to OMIG PERM team by filling out the PERM contact form also located on this page.

New York State Department of Health Medicaid Updates

Listed below are the links to further information provided in the DOH Medicaid updates regarding the Payment Error Rate Measurement Program.

Payment Error Rate Measurement Program Request for Medicaid Provider Documentation
DOH Medicaid Update April 2017
Volume 33, Number 4
Office of Medicaid Management

Payment Error Rate Measurement Program Request for Medicaid Provider Documentation
DOH Medicaid Update January 2014
Volume 30, Number 1
Office of Medicaid Management

Payment Error Rate Measurement Program Request for Medicaid Provider Documentation
DOH Medicaid Update July 2011
Volume 27, Number 10
Office of Medicaid Management

Payment Error Rate Measurement Program Request for Medicaid Provider Documentation
DOH Medicaid Update September 2010
Volume 26, Number 11
Office of Medicaid Management

Payment Error Rate Measurement (PERM) Program
DOH Medicaid Update December 2008
Volume 24, Number 14
Office of Medicaid Management

Payment Error Measurement Rate Program Update: Request for Medicaid Provider Documentation
DOH Medicaid Update April 2008
Volume 24, Number 5
Office of Medicaid Management

Payment Error Rate Measurement Program
DOH Medicaid Update October 2007
Volume 23, Number 10
Office of Medicaid Management

 

Contact PERM

Please contact PERM Project staff at (518) 402-7041, (518) 474-3499 or via email at: [email protected]