BC Advantage - 2013 Issue 12

The Latest Development in Federal Health Care Audit Programs: Supplemental Medical Review Contractor (

Jessica L. Gustafson, Esq.Abby Pendleton, Esq.The Health Law Partners, P.C. As health care providers and suppliers are very much aware, the Centers for Medicare & Medicaid Services (CMS) has adopted and implemented numerous Medicare auditing initiatives, each with a slightly different focus: Comprehensive Error Rate Testing (CERT) audits to measure improper payments in the Medicare fee for service (FFS) program  and Payment Error Rate Measurement (PERM) audits to estimate improper payments in Medicaid ; Medicare Administrative Contractor (MAC) audits and State Medicaid audits;Recovery audits (formerly known as Recovery Audit Contractor (RAC) audits) to identify and...

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