Baton Rouge, La. -- The Centers for Medicaid and Medicare Services released findings citing Louisiana's Department of Health and Hospitals for its exemplary Payment Error Rate Measurement (PERM) program rates for Medicaid and Children's Health Insurance Program (CHIP) in fiscal year 2012. Through strategic department initiatives, DHH posted a rate well below the national average PERM rate. PERM error rates reflect both underpayments and overpayments that may have been made incorrectly. PERM error rates are based on review of the fee-for-service (FFS), managed care and eligibility components of Medicaid and CHIP in the fiscal year under review. Two examples of errors include lack of proper documentation and providers billing the wrong number of units.
The 2012 National Medicaid error rate is 7.1 percent. DHH was below the national average with a combined rate of 2.3 percent, indicating less payment errors are found and reported in Louisiana. FFS and Eligibility percentages make up the combined rate with 2.0 percent and 0.3 percent respectively.
The 2012 National CHIP error rate is 8.2 percent. Again DHH had outstanding results, falling below the national average with a combined rate of 4.6 percent. FFS and Eligibility percentages make up the combined rate with 2.1 percent and 2.5 percent respectively. DHH does not have a percentage for managed care because Bayou Health was not fully implemented at the time of the CMS study.
"Over the years, DHH has worked with Medicaid recipients and parents of children in the LaCHIP program to explore how we can ease the eligibility and enrollment process," said DHH Secretary Kathy Kliebert. "We know that streamlining our administrative processes and efficiently managing both programs are keys to ensuring everyone enrolled in Medicaid and LaCHIP has timely access to the best care possible. Our outstanding PERM program rates are a reflection of DHH's committed staff and their strategic use of available resources."
DHH's low error rate can be attributed to several process improvement initiatives and procedural revisions that have streamlined the renewal process including:
The Claims Data component of PERM also attributed to DHH's low error rate by:
The implementations in eligibility and claims data effectively reduced waste and abuse of the programs as 97% of Medicaid payments and 96% of CHIP payments were appropriately paid out.
"Ultimately, by paying claims as we are supposed to through our payment policies, the Department ensures that funding is being spent the way it was budgeted," said DHH Undersecretary Jerry Phillips. "The lower the department's error rates, the more likely it is that those who need care are getting it."
For more information on the CMS PERM study please visit http://www.hhsc.state.tx.us/medicaid/FY-2010-12-PERM-State-Rates.pdf. For more information on Bayou Health of LACHIP please visit www.dhh.la.gov.