Attention All Providers: Payment Error Rate Measurement (PERM) Audit 

Maine Department of Health & Human Services sent this bulletin at 02/11/2022 10:51 AM EST

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Attention All Providers: Payment Error Rate Measurement (PERM) Audit 

 

The State of Maine has completed the process of a federally mandated PERM audit for Reporting Year 2021. (See e-message sent 02/06/2020.) This audit covered randomly selected paid claims with payments dated July 1, 2019 through June 30, 2020.  

 

Claims Submission 

 

It is a MaineCare provider’s responsibility to make sure that all claims sent to MaineCare are true and accurate. For each claim submitted, you must be sure to include the correct member name, member status, date of service, bill type, billed units and charges, and procedure codes. Claims should also include modifiers, medical assessments, daily shift notes, physician’s orders, home support provider census sheets, pre-authorizations, RUGS, admission dates, Attending National Provider Identifier (NPI), etc., as applicable.  

 

Maintaining Records 

 

MaineCare Benefits Manual Chapter I, Section 1.03 states that all providers must “Maintain and retain contemporaneous financial, provider, and professional records sufficient to fully and accurately document the nature, scope and details of the health care and/or related services or products provided to each individual MaineCare member” and that these records are kept “for a period of not less than five (5) years from the date of service or longer if necessary to meet other statutory requirements. If an audit is initiated within the required retention period, the records must be retained until the audit is completed and a settlement has been made.” 

 

The following list represents most common billing errors found in our last two PERM cycles. Providers also made billing errors not included in the list below. Before submitting a claim, check that the information for the member and the services provided are accurate and complete. Subsequent messages will include lists of the most common documentation errors and miscellaneous errors. Please review this document for the full list of the most common errors. 

 

Billing Errors are related to the information on the claim that the provider submitted to MaineCare. 

 

  • The provider did not see the beneficiary on the date of service on the claim. Before submitting a claim, make sure the documentation supports the date of service on the claim. 
  • The date of service is incorrect but is within seven days of the date of service billed on the claim. Although some billing can be done within a specified date span, be sure to list the date of service as the actual date you provided the services. For example, if a member is authorized to be seen once for services between Sunday and Saturday, and the service is provided on Wednesday, the date of service on the claim should be for Wednesday’s date.  
  • The number of units documented does not support the number of units billed. Be sure to bill the correct number of units on a claim. Keep accurate records so that the documentation supports the number of units billed.  
  • The provider billed for separate components of a bundled procedure code. Some service codes must be billed together, or bundled, on the same claim. Be sure to bill all bundled codes on the same claim.   
  • The provider did not list the required Attending National Provider Identifier (NPI) on the claim. Currently, claims missing the Attending NPI receive a WARN message and do not deny. In summer 2022, we anticipate removing the WARN edit and implementing a change to the system that will cause claims to deny if the claim does not include a required NPI. 
  • The provider inappropriately billed two or more services on the same date. For any individual member, for a given date of service, providers may not bill an individual service if that service is also included as part of a bundled service provided on the same date.  

 

For questions specific to Maine’s results, please contact Kealoha Rosso by phone at (207) 624-6929 or email at kealoha.e.rosso@maine.gov. Please DO NOT send medical records to this contact.