PAYMENT ERROR RATE MEASUREMENT PROJECT (2008) - UPDATE
This article is the third in a series of updates on the Payment Error Rate Measurement (PERM). The Improper Payments Information Act of 2002 (HR 4878) requires federal government agencies to estimate their improper payments annually. The Agency for Health Care Administration (the Agency) is Florida’s single state agency that administers the state’s Medicaid program; this includes the administration and management of funding for the State Children’s Health Insurance Program (SCHIP), also known as Florida KidCare. The Agency is cooperating with the Centers for Medicare and Medicaid Services (CMS) in this effort.
In our Spring 2007 Provider Bulletin the Agency stated that CMS will be measuring the accuracy of payments in the Medicaid and SCHIP (KidCare) programs. CMS will use national contractors to review claims related medical records, and to measure improper payments made in this context. Livanta is the federally contracted entity that will develop the documentation and database support for PERM by collecting medical records from providers. If you have submitted a claim for services given to a Medicaid or SCHIP beneficiary, it may be one of a sample of claims selected for review. Livanta will contact you for a copy of your medical records to support the medical review of the claim. The contractor will conduct medical reviews on all sampled Medicaid and SCHIP fee-for-service claims to determine if the claims were correctly paid, and medical records are needed for this purpose.
Please note that it is of utmost importance for you, the provider, and for the State of Florida, that all requests for medical records related to the selected claims sample made by the Federal data documentation contractor, Livanta, be submitted within a ninety-day (90) period. It is also of the utmost importance that the submitted medical records be complete so that the review contractor may be able to substantiate the claims. Incomplete records, or records insufficient to substantiate the claim will be counted as errors, and the State will be required to initiate payment recovery efforts in order to reimburse the Federal share of the payments determined to be improperly paid.
Livanta is a federally contracted agent of the Centers for Medicare and Medicaid and is authorized to request and receive medical records under the Payment Error Rate Measurement program.
Livanta will attempt to contact you at the location/telephone number you have on record with the Agency. If you have changed your address or telephone number, you are required to report the change of address to the Agency (General Provider Handbook, page 2-35).
If Livanta is either unable to contact you, or if it does not get a response from you within 90 days of making a request for medical records for a sampled claim, Livanta may determine that the claim was paid incorrectly, and as stated previously, the State will initiate recovery efforts.
Medical Records Requests
Please note that providers are required by Section 1902(a)(27) of the Social Security Act to retain records necessary to disclose the extent of services provided to individuals receiving assistance, and furnish CMS with information regarding any payments claimed by the provider for medical services, including medical records.
In addition, the collection and review of protected health information contained in individual level medical records, for payment review purposes, is permissible by the Health Information Portability and Accountability Act of 1996 (HIPAA) and implementing regulations at 45 Code of Federal Regulations, parts 160 and 164:
“…a covered entity may disclose protected health information to a health oversight agency for oversight activities authorized by law, including audits…or other activities necessary for the appropriate oversight of (1) the health care system; (2) government benefit programs for which health information is relevant to beneficiary eligibility; (3) entities subject to government regulatory programs for which health information is necessary for determining compliance with program standards; or (4) entities subject to civil rights laws for which health information is necessary for determining compliance.”
Additionally, as part of their Medicaid provider agreement responsibilities, Florida Medicaid providers are required to:
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Keep, maintain, and make available in a systematic and orderly manner, all medical and Medicaid-related records as the Agency requires for a period of at least five (5) years.
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Send, upon request, or as required by applicable handbooks, and at the provider’s expense, legible copies of all Medicaid-related information to authorized state and federal employees, including their agents. The provider shall give state and federal employees, including their agents, access to all Medicaid patient records and to other information that is inseparable from Medicaid-related records.
Please review subsequent bulletins for additional details regarding Payment Error Rate Measurement.
We appreciate your continued cooperation with Florida Medicaid. If you have any questions, please contact Karen Chang, Administrator, Office of Medicaid Program Oversight, by telephone at (850) 414-2513, or via email at changk@ahca.myflorida.com
If you have any questions regarding the identity of the contractors, you may contact either the contractors directly, or verify the identity with CMS directly using the contact information below:
Statistical Contractor
The Lewin Group
3130 Fairview Park Drive
Suite 800
Falls Church VA 22042
Fax: (703) 269-5705
Email us at cms.perm@lewin.com or call Moira Forbes at (703) 269-5631
Documentation/Database Contractor
For questions relating to submission of medical policies, medical record requests and tracking
Livanta LLC
9090 Junction Dr., Suite 9
Annapolis Junction, MD 20701
Fax: (240) 568-6063
Email Stephen Buckingham at sbuckingham@livanta.com or call (301) 957-2329
Review Contractor
For questions relating to medical and processing review protocols
HealthDataInsights, Inc
2620 Regatta Blvd., Suite 208
Las Vegas, NV 89128
(702) 243-8730
(702) 233-2167 fax
Email Linda Clark Helms at linda.clarkhelms@emailhdi.com or call (410) 221-9990
Centers for Medicare and Medicaid Services
For questions relating to the federal PERM regulation, contractor oversight
Centers for Medicare and Medicaid Services
Office of Financial Management, Program Integrity Group
7500 Security Blvd., Mail Stop C3-02-16
Baltimore MD 21244-1850
Email Janet Reichert, CMS PERM Project Officer at JReichert@cms.hhs.gov
