The Centers for Medicare and Medicaid Services (CMS) developed the Payment Error Rate Measurement (PERM) program in response to the Improper Payment Information Act, 2002 [IPIA, Public Law 107–300,] enacted November 26, 2002. This act requires federal agencies to review annually programs they oversee that are susceptible to significant erroneous payments, to estimate the amount of improper payments, to report those estimates to Congress and to submit a report of the actions the federal agency is taking to reduce erroneous expenditures. The Improper Payments Elimination and Recovery Act of 2010 (IPERA) enhances the IPIA of 2002 and aims to further reduce improper payments.
Payments made to all provider types will be part of the review process. Any claim that is paid by Vermont Medicaid between July 1, 2018 and June 30, 2019 will be part of the payment universe review. A sample of claims will be randomly drawn from each quarter, and these will be the claims reviewed by the federal contractor. If a claim you submitted is selected, you will be notified.
AdvanceMed, the medical review contractor for CMS, will contact providers and request a copy of their medical records to support the medical review. AdvanceMed will send out the request letters and, if necessary, follow-up letters and calls. Please note you are required to submit records at no cost to AdvanceMed. You cannot bill for cost of copying or mailing records.