Payment Error Rate Measurement (PERM) Program
The Centers for Medicare & Medicaid Services (CMS) selected The Lewin Group as the statistical contractor for the FY2007 PERM program.
The Lewin Group gained expertise in the PERM program through our work with CMS and many state Medicaid and State Children’s Health Insurance Program (SCHIP) programs since 2001. We pilot-tested various methodologies to measure payment error, and also implemented the FY2006 PERM measurement in Medicaid fee-for-service (FFS) in 17 states. The Lewin Group:
- Reviewed each state’s eligibility sampling plan to achieve an approvable plan
- Collected and analyzed Medicaid and SCHIP fee-for-service and managed care payment data
- Sampled fee-for-service line items and managed care capitation payments on a quarterly basis
- Calculated each state’s Medicaid and SCHIP program error rates
The Lewin Group works with the federal government, state agencies, and private health plans to facilitate timely, accurate, and appropriate reimbursement.
The Lewin Group brings together dedicated policy experts–renowned for their intellectual energy, analytical talent, integrity, and commitment to client satisfaction–with experienced reimbursement consultants to detect and mitigate improper payments for the federal government, state agencies, and private health plans.
We facilitate accurate payment for medically necessary and covered services delivered efficiently to eligible beneficiaries. Our work includes fraud and abuse detection and supports timely modifications to payment systems, policies, and methods to reduce payment error.
We work with our clients to provide comprehensive analysis, help them overcome obstacles, and implement effective strategies to facilitate payment integrity.
Payment Accuracy Assessment
- Assess payment accuracy using a variety of quantitative, statistical methods
- Identify system vulnerability
- Validate coding, medical necessity, and reimbursement
Fraud and Abuse Detection
- Develop pre- and post-payment screening models
- Identify outliers
- Develop provider network management strategies
Mitigation Strategies Including Provider Education
- Design, implement, and evaluate education programs
- Benchmark performance
- Establish medical necessity