Payment Error Rate Measurement (PERM) Reporting Year (RY) 2024 Errors

Feb 14, 2025

All errors found during a PERM audit are considered improper payments.Maine is required to reimburse the federal government for all improper payments and has the right to seek recoupment from providers for improper payments resulting from provider error.

The most common errors found in the RY 2024 PERM Audit cycle are listed below. The most common errors from the previous two PERM cycles are also included in the list. Before submitting a claim, check that the information for the member and the services provided are accurate and complete.

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. Institutional (UB) claims that are missing the attending provider requirement will deny the claim if the attending NPI is missing from the claim.
• 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.
• The provider responded with a statement that they had billed in error. Before submitting a claim, be sure to review the units billed and date of service for accuracy.

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 all 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.
• The provider did not submit the required supervision documentation.  For PNMI Appendix C requirements, please document the quarterly nursing review of the plan of care for personal care services.  The plan of care must be signed by the treatment team, including the member or guardian.
• The provider did not submit the required signed timesheet. Providers must maintain and provide timesheets with signatures as requested by PERM auditors to document when services were rendered, as required by policy section.
• The provider did not submit the individual plan (ITP, ISP, IFSP, IEP, or POC). Providers must maintain and provide individual plans of care with signatures as requested by PERM auditors to document when services were rendered, as required by policy section.
• Documentation has been altered. Medical documentation is considered a legal document and updates to these records require a strikethrough of the error, with initials and a date of the change, with the corrected information entered directly below the error.

Miscellaneous 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 respond to the request for records. If a provider does not respond to the request for records during the PERM audit, it is automatically considered a payment error so, please respond timely.
• The provider did not have the beneficiary on file or in the system.  It is the provider’s responsibility to maintain accurate records for each member and for each service provided to that member.
• The State could not locate the provider. If a provider has ceased operations, the provider must notify MaineCare that operations have ceased and must maintain records as defined in MaineCare Benefits Manual - Chapter 1, Section 1.03.
• The provider moved and did not notify MaineCare of the change. If a provider is moving locations, the provider must notify MaineCare as defined in MaineCare Benefits Manual - Chapter 1, Section 1.03.

For questions, please contact Kealoha Rosso, PERM Eligibility Specialist.