Date: July 30, 2021
To: Long Term Care Facilities - Nursing Facilities (NF) and Intermediate Care Facilities (ICF)
Re: Payment Error Rate Measurement (PERM) Audits
In the Provider Notice dated May 7, 2020, all Participating Medical Assistance Program Providers were reminded that all services for which charges are made to the Illinois Department of Healthcare and Family Services (the Department) are subject to Payment Error Rate Measurement (PERM) audits.
These audits are an important and necessary part of the Department's monitoring of health care facilities and services, as required by federal and State law. Audit findings against a provider will result in the recovery of resulting overpayments. Records for both Managed Care enrollees and Fee-For-Service (FFS) Medicaid recipients are subject to audit. Audit findings against a provider may also result in sanctions or other penalties, including but not limited to: (1) termination or suspension of the provider's eligibility to participate as a Medicaid and/or CHIP provider; (2) suspension or denial of the provider's payments; and (3) civil monetary penalties.
Common PERM errors cited include:
- No documentation
- Incomplete documentation
- Inadequate documentation
This Notice reminds Long Term Care (LTC) providers to maintain any and all professional records which relate to the quality of care given by the provider or which document the care for which payment is claimed. LTC providers should ensure their records have the supporting medical record documentation including but not limited to:
- Physician orders;
- Physician certification/recertification;
- All transfer forms;
- Admission face sheets;
- Documentation of daily patient presence;
- Leave of absence documentation;
- Medication administration record;
- Nursing assessment, notes, and flowsheets;
- Progress notes;
- Treatment administration records/notes; and
- Treatment plan.
This documentation should be complete, accurate and signed where appropriate.
Please refer to the Handbook for Providers of Medical Services Chapter 100 regarding Provider Enrollment (Topic 101) and Record Requirements (Topic 110).
If you have questions, contact the Bureau of Long Term Care toll free at 844-528-8444.
Kelly Cunningham, Administrator
Division of Medical Programs