| Report to Congressional Requesters: Medicaid Contributor(s): U. S. Department of the Interior (Author) |
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ISBN: 1503229033 ISBN-13: 9781503229037 Publisher: Createspace Independent Publishing Platform OUR PRICE: $15.19 Product Type: Paperback - Other Formats Published: January 2015 |
| Additional Information |
| BISAC Categories: - Reference |
| Physical Information: 0.13" H x 8.5" W x 11.02" (0.38 lbs) 64 pages |
| Descriptions, Reviews, Etc. |
| Publisher Description: The purpose of the CMS PERM program is to produce a national-level improper payment error rate for Medicaid. CMS developed PERM in order to comply with the requirements of IPIA, which was amended by IPERA. PERM uses a 17-state, 3-year rotation for measuring Medicaid improper payments. Medicaid improper payments are estimated on a federal fiscal year basis through the PERM process. The estimate measures three component error rates: (1) fee-for-service (FFS), (2) managed care, and (3) eligibility. FFS is a traditional method of paying for medical services under which providers are paid for each service rendered. Each selected FFS claim is subjected to a data processing review. The majority of FFS claims also undergo a medical review. Managed care is a system where the state contracts with health plans to deliver health services through a specified network of doctors and hospitals. Managed care claims are subject only to a data processing review. Eligibility refers to meeting the state's categorical and financial criteria for receipt of benefits under the Medicaid program. |
