Payment Error Rate Measurement (PERM)
FAQ:
What is PERM?
The Payment Error Rate Measurement (PERM) program measures improper payments in Medicaid and the State Children's Health Insurance Program (SCHIP) and produces state and national-level error rates for each program. The error rates are based on reviews of Medicaid and SCHIP fee-for-service (FFS) and managed care payments made in the Federal fiscal year (FY) under review.
Why was the PERM program created?
PERM was developed by the Centers for Medicare & Medicaid Services (CMS) to comply with the Improper Payments Information Act (IPIA) of 2002. The IPIA requires the heads of Federal agencies, including the Department of Health and Human Services (HHS), to annually review programs it administers and identify programs that may be susceptible to significant improper payments, estimate the amount of improper payments, submit those estimates to Congress, and submit a report on actions the agency is taking to reduce the improper payments. The IPIA directed the Office of Management and Budget (OMB) to provide guidance on implementation. OMB identified Medicaid and SCHIP as programs at risk for significant improper payments. Therefore, HHS must report the estimated error rates for the Medicaid and SCHIP programs each year for inclusion in the Performance and Accountability Report (PAR). CMS implemented the PERM program in a final rule published on August 31, 2007 (72 FR 50490).
What are the benefits of the PERM program?
The PERM program:
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Identifies program vulnerabilities that result in improper payments.
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Promotes efficient Medicaid and SCHIP program operations.
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Helps to ensure medical services are provided to the truly eligible.
How often are states measured under PERM?
PERM uses a 17-state rotational approach to measure improper payments in Medicaid and SCHIP for the 50 states and the District of Columbia over a three-year period. As a result, each state is measured once, and only once, every three years. Washington is being measured during Federal Fiscal Year 2008, for claims paid during October 1, 2007 through September 30, 2008.
Overview of PERM:
Information for providers:
- Numbered Memorandum 07-70
- CMS Provider Education Letter
- Medical Provider letter (Physicians, Hospitals, Pharmacies)
- Non-Medical Provider letter (Social Services, Transportation, Residential)
- Individual Provider letter (ADSA/DDD, Long Term Care)
- Section 1902 (a)(27) of the Social Security Act
- Health Insurance Portability and Accountability Act (HIPAA) of 1996
- 45 Code of Federal Regulations (CFR), parts 160 and 164
- Revised Code of Washington (RCW) 74.09.200
- Washington Administrative Code (WAC) 388-502a
- Core Provider Agreement
Who are the PERM contractors?
- Statistical Contractor Introduction
- Documentation/Database Contractor Introduction
- Review Contractor Introduction
Laws and Regulations:
Questions:
For more information or if you have questions, or Phone: 360-725-9981.
For comments or questions, email contact us
Page modified: November 2009
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