decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / AB-02-179
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Article Overview
This 2002 CMS Program Memorandum addresses how complaint screening responsibilities are divided between Affiliated Contractors and Program Safeguard Contractors when fraud or abuse concerns arise. It is relevant to Medicare operations, program integrity staff, and contractor personnel who handle complaint intake, referral, acknowledgment, and case development workflows. The article also outlines the administrative tracking and funding activity references associated with these complaint-handling functions.
Why This Topic Matters
The memorandum helps readers understand which contractor is responsible for screening, referring, acknowledging, and developing complaints, which affects program integrity operations and internal workflow compliance. It is useful for organizations working with Medicare complaint intake and fraud/abuse escalation processes.
Article Sections
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Program Memorandum
Introductory CMS memorandum details, including transmittal information, date, and change request context.
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Change Request 2406
Background for the complaint screening update and the scope of the memorandum’s instructions.
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Subject: Complaint Screening
Overview of the complaint screening topic and the contractor responsibilities addressed in the memorandum.
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AC Responsibilities
High-level description of the responsibilities assigned to affiliated contractors for screening, documentation, referral, and tracking of complaints.
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PSC Responsibilities
High-level description of the responsibilities assigned to program safeguard contractors for further development, acknowledgment, referral, and tracking of complaints.
What You Will Learn
- How the memorandum organizes complaint screening responsibilities between contractor entities
- What general types of complaint-handling tasks are covered
- How complaint referral, acknowledgment, and tracking processes are addressed at a high level
- What administrative and implementation timing information the memorandum includes
Who Should Read This
- Medicare contractor staff
- Program integrity personnel
- Compliance and operations teams
- Healthcare reimbursement administrators
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