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State Initiates Medicaid Payment Error Rate Measurement Program

The October edition of the Medicaid Update published Nov. 17th announces that the Centers for Medicare and Medicaid Services (CMS) will be measuring improper payments in the Medicaid and State Child Health Insurance programs under the Payment Error Rate Measurement (PERM) program. In partnership with the NYS Office of the Medicaid Inspector General (OMIG), Empower AI, the CMS review contractor, will be requesting documentation from providers for randomly selected claims to perform a medical review.

If a submitted Medicaid claim is selected for review, the CMS contractor and OMIG will request written documentation from the provider to substantiate the paid claim. Providers will be asked to submit copies of the specific medical documents for the patient. This will be requested in the letter received from the CMS contractor, with instructions to submit the records directly to the CMS contractor with a second copy sent to OMIG.

Requests for documentation are anticipated to begin in late fall 2023 and will involve claims paid between July 1, 2022 and June 30, 2023. Failure to provide requested records will result in a determination by CMS of erroneous payment, and OMIG will pursue recovery.

This marks the sixth time that NYS will be participating in the PERM program, most recently in Federal Fiscal Year (FFY) 2021. Authority for CMS and its partners to collect the information is provided under Sections 1902(a)(27) and 2107(b)(1) of the Social Security Act. Health Insurance Portability and Accountability Act of 1996 (HIPAA) statutes and regulations require providers to share such information upon request and specify that the information can be provided without patient consent.

Questions regarding the program are being fielded by the PERM Project Staff at 518-408-0844 or by email at PERMNY@omig.ny.gov.

Other Medicaid Update articles that may be of interest to members cover:

  • the Dec. 31, 2023 end of the Emergency Triage, Treat, and Transport (ET3) program, which allowed qualified participating ambulance providers to treat patients in place or transport to destinations other than the emergency department;
  • NYC Health Coverage Symposia training opportunities on Nov. 30th and Dec. 7th that will provide attendees with updates on Medicare open enrollment and 2024 changes, NYS Medicaid renewals, NY State of Health open enrollment, the Inflation Reduction Act, the No Surprises Act, NYC Care, and the NYS Elderly Pharmaceutical Insurance Coverage (EPIC) program; and
  • information on the annual Open Enrollment Period for NY State of Health, the NYS official health plan marketplace.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841