CPI Resources

Resources
Featured Resource
shirt pocket containing stethoscope and pen
Become a Medicare Provider: Are you a provider interested in serving Medicare patients?
For Providers

Learn about requirements for Annual Wellness Visits (AWVs): This video provides health care professionals with guidance to understand expectations and requirements when submitting documentation for AWVs for Medicare beneficiaries. Watch the video.

Protect yourself from identity theft: Medicare providers who have their identities stolen and used to bill Medicare may be held liable for overpayments – don’t let this happen to you. Learn the signs and protect yourself.

Find your MAC: Do you know our Medicare Administrative Contractors (MACs) can help you enroll or re-enroll, understand billing requirements, and answer other administrative questions you may have about Medicare? Access a list of CMS contractors in your state and find your MAC today.

Revalidate your Medicare Enrollment: Already a Medicare provider? Be sure to revalidate your Medicare enrollment. Check your revalidation due date and learn more about the different revalidation methods. Our revalidation application checklist (PDF) covers what you need to get started.

Withdraw from Medicare: We are sorry to see you go. If you have retired, surrendered your license, or no longer want to participate in the Medicare program, you should withdraw within 90 days. Report this change online through PECOS.

Update or get a new National Provider Number (NPI): Need an NPI? Do you have one and want to make sure your information is up to date? Log in to the NPI system, known as NPPES, to get started.

See the changes we've made to medical reviews: When claims are submitted accurately, everyone benefits. Learn how the new Targeted Probe and Educate (TPE) program better targets medical reviews, limits the number of claims requested, and puts an emphasis on education and assistance to correct claims.

Check your Open Payments data: Do you have payments reported in the Open Payments database? Find out on the Open Payments website or if you already have an account, log in to the portal to review.

Sign up for compliance updates: Subscribe to the provider compliance email list and be the first to know about events and opportunities to collaborate with CMS and your fellow providers.

 
Featured Resource
map of the united states
Strengthen your fight against Medicaid fraud, waste, and abuse: The Medicaid Program Integrity Strategy includes stronger audits and oversight functions, increased data sharing, and technical assistance.
For States

Comprehensive Medicaid Integrity Plan, FY 2019 – FY 2023  (PDF)
Explore the 5-year, comprehensive plan to protect taxpayer dollars in the Medicaid program by combatting fraud, waste and abuse.

Beneficiary Eligibility Reviews: As part of the Comprehensive Medicaid Integrity Plan for FYs 2019-2023 and the Medicaid Program Integrity Strategy, CMS is conducting beneficiary eligibility reviews. The primary goal of these reviews is to confirm that states’ Medicaid and Children’s Health Insurance Program (CHIP) beneficiary eligibility determinations are appropriate and that the federal match is correctly assessed.

Completed Medicaid and CHIP beneficiary eligibility review reports are included below:

California Medical Loss Ratio Examination Report  (PDF)
A key component of CMS’ managed care program integrity work is to conduct targeted examinations of selected states’ Medicaid Managed Care Plans’ (MCPs) financial reporting.  As part of this effort, CMS conducted an examination of the Medical Loss Ratio (MLR) reported by California’s 22 Medicaid MCPs to determine if the state’s previous review correctly identified findings and overpayments, and the documentation accepted by the state was reasonable to support the amounts included in the MLR calculation.

Strengthen safeguards in Personal Care Services: Read about noteworthy practices and CMS guidance in the CMS Medicaid Integrity Institute paper, Vulnerabilities and Mitigation Strategies in Medicaid Personal Care Services (PDF) and the CMS FAQ on Allowability of Using National Provider Identifiers (NPIs) for Medicaid Personal Care Attendants (PCAs) (PDF).

Join the fight against the opioid epidemic: The Medicaid Integrity Institute Compendium of Promising Practices explores how states are addressing program integrity vulnerabilities produced by opioid misuse and abuse. Learn more. (PDF)

Join the Healthcare Fraud Prevention Partnership: Learn how sharing data with others in the healthcare industry, both public and private entities, can help your organization identify and reduce fraud, waste, and abuse across the healthcare sector. Learn more about the HFPP and find out how to become a partner.

Learn the latest in fraud schemes and detection: The Medicaid Integrity Institute (MII) exists to educate and train our state partners. Located in Columbia, South Carolina and developed by CMS in partnership with the Department of Justice, MII brings together experts - including law enforcement - to deliver up-to-date information on trends and strategies. See the latest course offerings on the MII training page.

Find guidance on federal Medicaid enrollment standards: The Medicaid Provider Enrollment Compendium (MPEC) is one of many resources available to state Medicaid agencies on Medicaid.gov's Medicaid program integrity resources page. Specifically, the MPEC provides guidance and clarification to help Medicaid agencies comply with regulations around Disclosure of Information by Providers, and Fiscal Agents and Provider Screening and Enrollment.

Stay on top of Medicaid best practices and fraud prevention: Visit the Medicaid Integrity Program pages to find toolkits, videos, podcasts, and more to help eliminate fraud, waste, and abuse.

 
Featured Resource
Healthcare Fraud Prevention Partnership
Join the Healthcare Fraud Prevention Partnership: Learn how sharing data with others in the health care industry can help fight fraud, waste, and abuse.
For Partners

New Medicare cards have arrived! By now, all people on Medicare should have received their new cards with their new Medicare ID numbers. But just because the cards are all mailed doesn't mean the fraud schemes stop. Anyone suspecting healthcare fraud, waste or abuse is encouraged to report it. Our Reporting Fraud page lists the different options for doing so.

Check the Open Payments data: The Open Payments program publishes information about payments made to providers and teaching hospitals by the pharmaceutical and medical device industries. Find out more on the Open Payments website.

 
Featured Resource
Program Integrity Knowledge and Resource Center
Take the Extrapolation/Estimation eLearning Course: Are you a program integrity professional who calculates overpayments?
For Program Integrity Personnel

CPI’s eLearning solutions will help program integrity personnel (including medical review, program integrity and appeals contractors, CMS staff, state Medicaid agency staff, and other stakeholders) consistently interpret CMS policies and procedures. They are designed to help reduce improper payments, claim denials, and appeals.

Learn about calculating overpayments with the latest CPI training: The Extrapolation/Estimation course, intended primarily for statisticians and adjudicators, provides instruction based on the new Program Integrity Manual (PIM) 8.4 (PDF) guidelines and focuses on the methodology for calculating an estimation of overpayment. This training is designed to help you interpret CMS policies and procedures consistently with others doing the same work.

Find out more on the Program Integrity Knowledge and Resources page.

 

Stay Up to Date with CPI

Connect with CPI as we host or attend various events throughout the year, join our mailing list to stay informed on Program Integrity news, or find the most appropriate vehicle to report suspected fraud, waste, or abuse.

Page Last Modified:
12/02/2020 09:53 AM