The Centers for Medicare and Medicaid Services (CMS) is conducting the Payment Error Rate Measurement (PERM) review to assess the occurrence of improper payments in Medicaid in accordance with the Improper Payments Information Act (IPIA) of 2002, the Improper Payments Elimination and Recovery Act (IPERA) of 2010, the Improper Payment Elimination and Recovery Improvement Act (IPERIA) of 2012, and the Payment Integrity Information Act (PIIA) of 2019. As part of this program, medical records of sampled claims will be reviewed to ensure that all paid claims were medically necessary and billed appropriately. Nebraska Medicaid staff will be working with the contractor and providers to ensure all requested documentation will be received in order to avoid errors.
As mandated, Nebraska participates in PERM every three years. Nebraska will participate in the PERM review of state fiscal year 2022 (July 1, 2021 through June 30, 2022) for both Medicaid and the Children's Health Insurance Program (CHIP), reviewing claims and eligibility determinations.
We recognize providers are concerned with maintaining the privacy of patient information. However, the collection and review of protected health information contained in individual-level medical records for payment review purposes is allowed by the Health Insurance Portability and Accountability Act (HIPAA) and implementing regulations at 45 Code of Federal Regulations (CFR), parts 160 and 164. This permits the collection and review of protected health information to meet the CMS PERM requirements.
Providers Will Be Receiving Record Requests
As part of the review process, the contractor retained by CMS will randomly select claims for a medical record review. The claims selected will be from all claims paid by Nebraska Medicaid from July 1, 2021 through June 30, 2022. Approximately 300 claims will be randomly selected for review. Since the claims will be sampled randomly, some providers may have more than one service selected for a medical record review. It also means that there are some providers who will not have any claims selected at all.
All providers with claims sampled for the PERM review will receive a letter from a federal contractor. Providers may be contacted by phone in advance of receiving this letter to verify the address and/or fax number. Letters will be on CMS letterhead. Letters will request medical records for the particular service that was performed by the provider. The provider will have 75 calendar days to submit the requested documentation before the claim will be found to have been paid in error. The letter requesting records will have a date at the top identifying when records must be submitted. Providers will also receive follow-up notices if records have not yet been received by the contractor. If records are not submitted and the claim is found to have been paid in error, Nebraska Medicaid will request a refund from that provider for that service.
If you have any questions about the review process, or if you want to verify that a request for records that you have received in genuine, please contact Betsie Steenson at (402) 471-9353 or by email at firstname.lastname@example.org. Please do not include any Protected Health Information (PHI) in unsecured email transactions.
If you would like more information about the rules and regulations relating to PERM, please visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Improper-Payment-Measurement-Programs/PERM.
For general PERM program and provider specific questions, CMS may be contacted at PERMProviders@cms.hhs.gov, and questions related to the current review can be sent to PERMRC_Providerinquiries@nciinc.com.