Payment Error Rate Measurement (PERM)

Evolution and key components of the PERM program, including measuring Medicaid and CHIP payment errors, legal basis, program timeline, state responsibilities, and CMS team duties.

• Payment Error Rate
• Medicaid
• CHIP
• Program Evolution
• State Responsibilities

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Uploaded on Feb 20, 2025 | 0 Views

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Presentation Transcript

1. Payment Error Rate Measurement (PERM) Introduction to PERM June 2018 Centers for Medicare & Medicaid Services

2. Agenda 1

4. Legal Basis for Measuring Medicaid and CHIP Improper Payments 3

5. Continuing Evolution of the PERM Program 4

6. Summary of PERM 2017 Final Rule 5

7. Summary of PERM 2017 Final Rule 6

8. Summary of PERM 2017 Final Rule 7

9. PERM Cycle Progression RY 2020 PERM Cycle Timeline 8

11. Measuring Payment Errors in Medicaid and CHIP 10

12. PERM State Rotation 11

13. PERM Review Types and Sample Sizes 12

14. PERM Cycle Progression 13

16. CMS PERM Team Responsibilities 15

17. General State Responsibilities 16

18. State Responsibilities to the SC 17

19. State Responsibilities to the SC 18

20. State Responsibilities to the RC 19

21. State Responsibilities to the ERC 20

22. Statistical Contractor Responsibilities 21

23. Statistical Contractor Responsibilities 22

24. Review Contractor Responsibilities 23

25. Review Contractor Responsibilities 24

26. Eligibility Review Contractor Responsibilities 25

27. Eligibility Review Contractor Responsibilities 26

29. SC Processes: Difference between cycles (FY16 & RY20) 28

30. SC Processes: Difference between cycles (FY16 & RY20) 29

31. SC Processes: New to Cycle 2 States 30

32. Difference between cycles (FY16 & RY20) 31

33. RC Processes: Difference between cycles (FY16 & RY20) 32

34. RC Processes: New to Cycle 2 States 33

35. ERC Processes: New to Cycle 2 States 34

37. Statistical Contractor: Universe Collection and Sampling 36

38. Statistical Contractor: Universe Collection 37

39. Statistical Contractor: Sampling 38

40. Statistical Contractor: Improper Payment Rate Calculation 39

41. Review Contractor: Collection of State Policies 40

42. Review Contractor: Data Processing Reviews 41

43. Review Contractor: Data Processing Reviews Beneficiary Review 42

44. Review Contractor: Data Processing Reviews Verification of Provider Enrollment 43

45. Review Contractor: Data Processing Reviews Verification of Accurate Payment 44

46. Review Contractor: Data Processing Reviews Verification of Accurate Payment Does the state make retroactive rate adjustments? 45

47. Review Contractor: Data Processing Reviews - Managed Care Capitation Payment 46

48. Review Contractor: Medical Record Requests 47

49. Review Contractor: Medical Record Requests 48

50. Review Contractor: Medical Reviews 49

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