Author: Office of Compliance and Program Integrity
The Payment Error Rate Measurement (PERM) audit calculates error rates for Medicaid, Children’s Health Insurance Programs (CHIP) and Managed Care on a three-year cycle for the Centers for Medicare & Medicaid Services (CMS). The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of those three programs in the fiscal year under review.
Note: NC Health Choice (NCHC) is the state’s CHIP program.
The PERM audit for Federal Fiscal Year (FFY) 2016 reviewed claims for service dates between Oct. 1, 2015 – Sept. 30, 2016.
Most of North Carolina’s FFY 2016 errors were due to the following provider billing errors:
- Missing or insufficient documentation to support the service billed
- Required document missing from the medical record
- Procedure Coding Error
- Incorrect date of service (DOS) billed
- Attending, rendering or ordering provider not enrolled in Medicaid, CHIP or Managed Care
- Duplicate claim submissions
Providers can reduce the likelihood of future billing errors by:
- Using the NCTracks Provider Portal to access web-based tutorials, classes and training materials to educate themselves and their billing personnel on all aspects of claims submission
- Implementing an internal quality assurance program which includes regular review for the billing errors listed above
- Incorporating review of claims submissions as a component of any internal quality assurance program
- Identifying overpayments as part of a voluntary self-audit (also see self-audit overview document)
- Reviewing Medicaid’s monthly Medicaid Bulletin to stay abreast of changes that may impact billing.
Office of Compliance and Program Integrity
DMA, 919-814-0000