DATE:June 27, 2008
TO:MaineCare Providers
FROM:Anthony F. Marple
Director, MaineCare Services
SUBJECT:Explanation of Payment Error Rate Measurement (PERM) Program
Summary
Over the next year you may be asked to submit medical records for MaineCare Members to a contractor who is conducting an audit of MaineCare eligibility and claims for the federal Center for Medicare and Medicaid Services (CMS). CMS is required to audit each state once every three years. Maine is being audited for federal fiscal year 2008 (October 2007 through September 2008).
It is critical for you to submit complete records within 90 days. If records are
not submitted on time, or if the records are not complete, Maine will be charged
withan error. If the error involves a claim, Maine may have to reimburse the
federal government for the federal match. If Maine has to reimburse the federal government,we may seek reimbursement from providers who did not comply
with federal law.
You will be contacted by telephone. If the contractor is unable to contact you,
Maine will be charged with an error. The telephone number the contractor will
use is based on the telephone number MaineCare has for you. If you have recently changed your telephone number please contact MaineCare Provider Enrollment
by calling 1-800-321-5557, Option 6.
PERM Program Description
As background, CMS will measure the accuracy of Medicaid and SCHIP payments through the Payment Error Rate Measurement (PERM) program. Under the PERM program, CMS will use three national contractors to measure improper payments in Medicaid and SCHIP. As the statistical contractor, The Lewin Group will identify the claims to be reviewed. As the documentation and database contractor, Livanta LLC will collect medical records from the providers. And as the review contractor, HealthDataInsights will review medical and data processing of the selected claims to identify any improper payments.
If a claim is selected in a sample for a service that you rendered to either a MaineCare or SCHIP recipient, Livanta LLC will contact you by telephone. They will verify your correct name and address information and ask you how you want to receive the request for medical records (fax or U.S. mail). Once you receive the request you must submit the information electronically or
in hard copy within 90 days. Livanta LLC and MaineCare Services will follow up with you to ensure that you are able to submit the records before the 90-day timeframe has expired.
We know that you are concerned with maintaining the privacy of patient information. As you know, providers are required to retain and furnish records, including medical records to CMS about any payments claimed by the provider for services to MaineCare and SCHIP recipients. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) permits the furnishing of protected health information contained in individual-level medical records for payment review.
If Livanta LLC requests medical records from you and you have any questions, please contact Robin Reed, Livanta’s Medical Record manager at (301) 957-2380. You may also contact the MaineCare PERM audit team at 207-287-5975.
Thank you for your support of the PERM program.