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Contractor Entities at a Glance: Who May Contact You about Specific Centers for Medicare & Medicaid Services (CMS) Activities

CMS has received calls from providers about the various entities that may contact them with questions and requests for medical records, documentation, or other information. CMS recognizes that shifts in contracting entities due to recent Medicare Contracting Reform may be confusing. CMS has prepared this Special Edition article to describe the current Medicare contracting environment. In addition, this article will list the entities responsible for activities in the Medicare Program, as well as with some Medicaid claims, and explain the reasons why they may contact you. Some entities that may contact you are: • Medicaid Integrity Contractors (MICs) are entities that conduct audit-related activities for the Medicaid programs. • FFS Recovery Auditors (RAC) are entities that contract with CMS to identify Medicare Fee-For-Service (FFS) improper payments (underpayments and overpayments) and correct the improper payment(s). • Medicaid Recovery Auditors are responsible for identifying and recovering Medicaid overpayments and identifying underpayments. • Zone Program Integrity Contractors (ZPICs) are entities that identify cases of suspected fraud and take appropriate action. • CERT Program measures improper payments in the Medicare FFS program. • Payment Error Rate Measurement (PERM) Contractors measure improper payments in the Medicaid and Children’s Health Insurance Program.

INDUSTRY NEWS TAGS: CMS


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