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

May 16, 2022

The State of Maine has completed the process of a federally mandated PERM audit for Reporting Year 2021. The information below will help you avoid errors that could result in the need to pay MaineCare back.

This audit covered randomly selected paid claims with payments dated July 1, 2019, through June 30, 2020. See the e-message from February 6, 2020, that notified providers about the audit.

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, providers must be sure to include the correct member name, member status, date of service, bill type, billed units and charges, procedure codes, Resource Utilization Groups (RUGs), admission dates, Attending National Provider Identifier (NPI), and appropriate modifiers. Providers must retain supporting documentation in the member record, including but not limited to medical assessments, daily shift notes, physician’s orders, home support provider census sheets, and pre-authorizations, 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 must be 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 the most common documentation errors found in our last two PERM cycles. We sent a message previously about billing errors, and a subsequent message will include a list of miscellaneous errors. Please review this document for the full list of the most common errors.

Documentation Errors may be related to the information on the claim that the provider submitted to MaineCare or to the information that the provider submitted during the PERM audit.

• The provider did not submit required progress notes for the sampled Date of Service (DOS). Be sure to keep accurate progress notes for each DOS.
• The provider did not submit the service plan when required. Please document the service plan.
• The record does not include a physician’s order for the service. Document physicians’ orders to support the service provided.
• The provider did not include required start and stop times for the DOS. Be sure to record the start and stop times for all services that require documentation of the start and stop times.
• Multiple documents are missing from the record that are required to support payment. Please keep accurate records that support the claim.
• The provider did not submit a record with daily documentation of specific tasks performed on the DOS. Be sure to keep accurate records of specific tasks performed for each service.
• The provider did not submit the test result. Please keep medical test results in the medical record.
• The provider did not include the required provider signature and/or credentials. Be sure the provider signs orders when needed and includes their credentials.
• The provider submitted a record for the wrong DOS. When sending documents to the PERM auditors, be sure to send documents for the correct DOS.

Please contact Kealoha Rosso by phone at (207) 624-6929 or email at kealoha.e.rosso@maine.gov for State of Maine-specific questions. Please DO NOT send medical records to this contact.

You can email CMS with general questions on the federal PERM program at PERMProviders@cms.hhs.gov. Please DO NOT send medical records to this contact.