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, 2021 and June 30, 2022 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.
NCI Information Systems, the medical review contractor for CMS, will contact providers and request a copy of their medical records to support the medical review. NCI Information Systems 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 NCI Information Systems. You cannot bill for cost of copying or mailing records.
Notices & Information
RY 2023 PERM Audit Information (Updated Timeline Info posted 5/12/22)
Example Initial Request for Medical Records Letter - This document includes an example of the letter providers with a sampled claim will receive (on CMS letterhead), as well as submission instructions, and a cover sheet template.
Example Additional Documentation Request Letter - This document includes an example of the letter requesting additional documentation, as well as submission instructions, and a cover sheet template.
Claim Category Matrix - This document indicates what records are needed for different claim types.
CMS PERM Page for Providers - This webpage has links to a PERM overview in PDF or Webinar format.