Health care providers in New York that participate in Medicaid may be included in the latest cycle of the Centers for Medicare and Medicaid Services Payment Error Rate Measurement Program (“PERM”). PERM was developed in response to the Improper Payment Information Act, which requires that Federal agencies review programs that are prone to erroneous payments on an annual basis. The PERM Program reviews each state once every three years.
The New York State Medicaid Program is included in the current PERM cycle. As a result, CMS will review a random sample of fee-for-service (FFS) Medicaid payments submitted by providers between October 1, 2010 and September 30, 2011.
CMS began contacting providers in October 2011 and will continue with such requests until mid-2012. CMS initiates the request by calling the affected service provider, explaining the PERM process and requesting provider records for review. The calls are followed up by a written request for specific medical records.
Providers have seventy-five (75) days to respond to CMS’s request for documentation on the targeted FFS. If a provider does not respond within that time frame, CMS will determine that there is no evidence to adequately establish whether the services were provided, medically necessary or properly coded or paid. Not responding to a CMS request will likely result in a recoupment request by the NYS Office of the Medicaid Inspector General.
If CMS determines that an erroneous payment was made, the NYS Office of the Medicaid Inspector General may recover those erroneous payments from the health care provider. Providers will be afforded normal appeal rights with New York State if such an error is determined.
There are certain “best practices” that health care providers should follow when dealing with a PERM Program request, including:
- being knowledgeable about state Medicaid policies for their provider type and maintaining accurate documentation as required by state policies;
- designating a point of contact to hand record requests;
- making the request a priority and reviewing it as soon as it is received;
- viewing the record for document/image readability quality;
- understanding that sending billing information is not sufficient proof that services were provided; and
- maintaining a copy of the documentation sent to CMS in order to be able to reference it upon any follow-up calls by CMS to the service provider.