June 28, 2018
If you are a Medicaid and CHIP provider, please be aware of the latest post-payment claims reviewer we have detailed here.
We anticipate providers will be faced with additional stress and burden when this new PERM RC request letter for production of medical records arrives.
A five-year contract, valued at $44 million with the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid (CMS), establishes that NCI will perform claims review to support the national-level improper payment rates for Medicaid and the Children’s Health Insurance Program (CHIP). The results of claims reviewed will be reported to Congress as required by the Improper Payments Elimination and Recovery Act of 2010.
In its new role as a PERM RC, NCI will help develop and produce the national report on Medicaid and CHIP improper payments that CMS provides to Congress each year. NCI will be required to follow this checklist during its claim review:
- Research state Medicaid and CHIP policies;
- Request and collect medical records from providers;
- Perform data processing and medical reviews of Medicaid and CHIP claims to determine if claims were paid correctly or in error;
- Meet with state offices to process/analyze reviews and incorporate the results into the State Medicaid Error Rate Findings system.
With its longstanding commitment to reducing claim payment errors and to fighting fraud, waste, and abuse in entitlement programs, NCI will continue to support CMS and its new program.
There will likely be more PERM contractors awarded to support national report development and production.
Matthew Roberts,Esq. is a Member ofNexsen Pruet based in Columbia, South Carolina. He leads thefirm's Health Care Practice Group and is admitted in North and South Carolina.
Stephen Bittinger, Esq. is a Member of Nexsen Pruet based in Charleston, South Carolina. Stephen is admitted in North Carolina, Ohio and the District of Columbia. He is not licensed to practice law in South Carolina. Stephen has a unique, national practice in health care reimbursement defense and litigation.