Maintaining Complete Medical Records and Updating Contact Information Information for providers to prepare for the reporting year 2023 Payment Error Rate Measurement audit.
Please share this information with administrative, clinical and billing staff.
The purpose of this bulletin is to notify providers of the upcoming Reporting Year 2023 Payment Error Rate Measurement (PERM) audit. The Improper Payments Information Act of 2002 (IPIA), Public Law 107-300 measures and reports a national improper payment rate for Medicaid and the Children’s Health Insurance Program (CHIP) to comply with the requirements.
The PERM audit will sample fee-for-service claims and managed care capitation payments collected for a full year – July 1, 2021, through June 30, 2022. The North Carolina Department of Health and Human Services (DHHS), Division of Health Benefits (DHB) is reminding providers of their obligation under § 108C-11 to have all contact information current and 10A NCAC 22F.0107 maintain medical records and to supply records when requested.
State and federal regulations require that providers must keep, maintain for six years, and provide complete medical records for all Medicaid and CHIP recipients (see 45 CFR 164.530(j). Complete documentation must reflect the service provided, and who provided the service, and all additional details relevant to the service.
As stated in the NC DHHS Provider Administrative Participation Agreement, Section 5, the submission of the claim by the provider, the provider’s authorized representative, or the provider’s billing agent on behalf of the approved provider certifies that each service is documented in the provider’s files, and that documentation is available to the Department.
Regulations also require documentation for services provided to Medicaid and CHIP recipients to be made available when requested (10A NCAC 22F.0107). These records must be supplied in a timely manner for audit or review when requested by the Centers for Medicare and Medicaid Services (CMS) contractor (NCI Information Systems Inc.) on behalf of DHHS.
With Health Insurance Portability and Accountability Act (HIPAA) privacy laws, many providers are concerned about the validity of documentation requests. If you receive a request for records and are uncertain if the request is valid, please contact the North Carolina Office of Compliance and Program Integrity Unit for confirmation at https://medicaid.ncdhhs.gov/meetings-notices/ocpifraud-waste-and-abuse or 919-268-6481.
If you have questions regarding this bulletin, please contact Betty Dumas-Beasley at
Medicaid provider bulletins are available at https://medicaid.ncdhhs.gov/providers/medicaid-bulletin.