100-08 Medicare Program Integrity Manual: Chapter 1 - Overview of Medical Review (MR) and Program Integrity (PI) Programs

Medicare Program Integrity Manual
Chapter 1 - Overview of Medical Review (MR) and
Program Integrity (PI) Programs
Table of Contents
(Rev. 12772; Issued: 08-09-24)
Transmittals for Chapter 1
1.1- Overview of Program Integrity and Provider Compliance
1.2 - Definitions
1.3 - Medicare Improper Payment Reduction Efforts – Provider Compliance
1.3.1 – Types of Contractors
1.3.2 – Improper Payment Prevention Goals
1.3.3 – Applicable of Problem Integrity Manual Sections
1.3.4 – Performance Metrics
1.3.5 – Types of Claims for Which Contractors Are Responsible
1.3.6 – Quality of Care Issues and Potential Fraud Issues
1.3.7 – The MAC and SMRC Medical Review Program
1.3.8 – Goal of MAC and SMRC MR Program
1.3.9 – Provider Self Audits
1.3.10 – Coordination Among Contractors
1.4 - Contractor Medical Director (CMD)
1.5 - Medical Review Manager
1.6 – Maintaining the Confidentiality of MR Medical Records and Documents
1.7 – Program Integrity
1.8 – Medical Review for Program Integrity (MR for PI)

1.1- Overview of Program Integrity and Provider Compliance
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
The term “Review Contractor” throughout the Program Integrity Manual refers to:
• 	Medicare Administrative Contractors (MACs)
• 	Comprehensive Error Rate Testing (CERT) contractors
• 	Recovery Auditors
• 	Unified Program Integrity Contractors (UPICs)
• 	Supplemental Medical Review Contractor (SMRC)
Review Contractors shall follow all sections of the PIM unless otherwise indicated as
required by their applicable Statements of Work (SOW).
1.2 - Definitions
(Rev. 313; Issued: 11-20-09; Effective/Implementation Date: 12-21-09)
To facilitate understanding, the terms used in the PIM are defined in Exhibit 1.
1.3 – Medicare Improper Payment Reduction Efforts – Provider
Compliance
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that
operates the Medicare program. Addressing improper payments in the Medicare fee-for-
service (FFS) program and promoting compliance with Medicare coverage and coding
rules is a top priority for the CMS. Preventing Medicare improper payments requires the
active involvement of every component of CMS and effective coordination with its
partners including various Medicare contractors and providers. The CMS contracts with
various types of contractors in its effort to fight improper payments and promote provider
compliance in the Medicare FFS program:
• 	CERT contractors;
• 	MACs;
• 	Recovery auditors; and
• 	SMRC.
1.3.1 - Types of Contractors
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
A. CERT Contractors
The CMS implemented the CERT program which establishes error rates and estimates of
improper payments that is compliant with the Improper Payments Elimination and
Recovery Improvement Act (IPERIA).
B. MACs

The MACs primarily use error rates produced by the CERT program and vulnerabilities
identified through the Recovery Audit program to identify where to target their improper
payment prevention efforts. The MACs analyze their internal data to determine which
corrective actions would be best to prevent the CERT-identified and Recovery Auditor-
identified vulnerabilities in the future. The CMS has determined that most improper
payments in the Medicare FFS program occur because a provider did not comply with
Medicare’s coverage, coding, or billing rules. The cornerstone of the MACs’ efforts to
prevent improper payments is each contractor’s Error Rate Reduction Plan (ERRP),
which includes initiatives to help providers comply with the rules. These initiatives
usually fall into one of three categories:
1. 	Targeted provider education to items or services with the highest improper
payments,
2. 	Prepayment and postpayment claim review targeted to those services with the
highest improper payments. 	In addition, in order to encourage providers to
submit claims correctly, MACs can perform extrapolation reviews as needed, and
3. 	New or revised local coverage determinations, articles or coding instructions to
assist providers in understanding how to correctly submit claims and under what
circumstances the services will be considered reasonable and necessary.
See section 1.3.6, for information on quality of care and potential fraud issues.
C. Recovery Auditors
Although CMS, through the MACs have undertaken actions to prevent future improper
payments, it is difficult to prevent all improper payments, considering that the Medicare
FFS program processes more than 1 billion claims each year. The CMS uses the
Recovery Audit program to detect and correct improper payments in the Medicare FFS
program and provide information to CMS and review contractors that could help protect
the Medicare Trust Funds by preventing future improper payments.
D. Supplemental MR Contractor (SMRC)
The Supplemental Medical Review Contractor’s (SMRC) main tasks are to perform
and/or provide support for a variety of tasks aimed at lowering the improper payment
rates and increasing efficiencies of the medical review functions of the Medicare and
Medicaid programs. Having a centralized medical review (MR) resource that can perform
large volume MR nationally allows for a timely and consistent execution of MR review,
activities and decisions. The focus of the reviews may include but are not limited to
issues identified by CMS internal data analysis, the CERT program, professional
organizations and other Federal agencies, such as the OIG/GAO and comparative billing
reports.
1.3.2 - Improper Payment Prevention Goals
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)

The CMS strives in every case to pay the right amount to a legitimate provider, for
covered, correctly coded and correctly billed services, provided to an eligible beneficiary.
To achieve the goal of improving provider compliance and lowering the error rate, CMS
follows three parallel strategies:
• 	Preventing improper payments through MACs and SMRC evaluation of program
vulnerabilities and taking the necessary action to prevent the identified
vulnerabilities in the future
• 	Correcting past improper payments through postpayment claim review by the
Recovery Auditors
• 	Measuring improper payments and pinpointing the causes of improper payments
by calculating service specific, provider type and contractor specific error rates by
the CERT contractors
1.3.3 - Applicable Program Integrity Manual Sections
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
• 	The MACs, CERT, Recovery Auditors, UPICs, and SMRC shall follow all
sections of the PIM unless otherwise indicated
• 	The MACs, CERT, Recovery Auditors, UPICs and SMRC shall follow the
PIM to the extent outlined in their SOWs.
1.3.4 - Performance Metrics
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
A. MAC MR Units Performance
The MAC MR Unit performance is measured by:
• 	CERT: CERT is a CMS program that measures a contractor’s payment error
rate.
• 	In addition, the MACs are measured by other measures listed in the MAC SOW.
B. Recovery Auditor Performance:
One key measure of Recovery Auditor performance is the Recovery Auditor accuracy
rate. CMS will produce a Recovery Auditor accuracy rate for each Recovery Auditor on
an annual basis. These rates will be released to the public through the annual Report to
Congress.
C. CERT Performance
The CERT performance metrics are listed in the contractors’ SOW. One key measure of
CERT performance is the timely production of the national error rate each year.

D. SMRC
A performance measure of the SMRC contractor is the accuracy rate. This will be
coordinated by CMS annually. Additional performance measures are listed in their SOW.
1.3.5 - Types of Claims for Which Contractors Are Responsible
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
A. MACs
The MACs should, at their discretion perform medical review functions for all claims
appropriately submitted to them.
Although they will continue to perform a number of quality functions, quality
improvement organizations (QIOs) will no longer be performing the majority of
utilization reviews for acute inpatient prospective payment system (IPPS) hospital and
long-term care hospital (LTCH) claims. The review of acute IPPS hospital and LTCH
claims (which, for the purposes of this section, also includes claims from any hospital
that would be subject to the IPPS or LTCH PPS had it not been granted a waiver) is now
the responsibility of the ACs and MACs. An exception occurs when a provider requests
a higher-weighted diagnosis related group (DRG) review from the QIO. The QIO will
continue to perform those reviews. QIOs will also continue to perform reviews related to
quality of care and expedited determinations.
The MACs shall include claims for which they are responsible when performing data
analysis to plan their medical review strategy. Amendments to plans and strategies shall
be made as needed if analysis indicates adjustment of priorities.
B. CERT
The CERT review contractor is responsible for reviewing claims randomly selected by
the CERT statistical contractor.
C. Recovery Auditors
In general, Recovery Auditors are responsible for reviewing claims where improper
payments have been made or there is a high probability that improper payments were
made.
D. SMRC
Medical review will be performed on Part A, Part B, and DME providers and suppliers as
directed by CMS.

1.3.6 - Quality of Care Issues and Potential Fraud Issues
(Rev. 12772; Issued: 08-09-24; Effective: 09-20-24; Implementation: 09-20-24)
Potential quality of care issues are not the responsibility of the MAC, CERT or Recovery
Auditor, UPIC, and SMRC but they are the responsibility of the QIO, State
licensing/survey and certification agency, or other appropriate entity in the service area.
MACs, CERT, Recovery Auditor, UPICs and SMRC shall refer quality of care issues to
the QIO, State licensing/survey and certification agency, or other appropriate entity in the
service area. See chapter 3, section 3.1, for a discussion of how contractors should handle
situations where providers are non-compliant with Medicare conditions of participation.
Contractors shall analyze provider compliance with Medicare coverage and coding rules
and take appropriate corrective action when providers are found to be non-compliant. For
repeated infractions, or infractions showing potential fraud or pattern of abuse, more
severe administrative action shall be initiated. At any time, evidence of fraud shall result
in referral to the UPICs for development. See chapter 4, section 4.9.4.2 for a discussion
on program integrity interaction with QIOs.
1.3.7 - The MAC and SMRC Medical Review Program
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
The MR program is designed to prevent improper payments in the Medicare FFS
program. Whenever possible, MACs are encouraged to automate this process; however
it may require the evaluation of medical records and related documents to determine
whether Medicare claims were billed in compliance with coverage, coding, payment,
and billing policies.
The statutory authority for the MR program includes the following sections of the
Social Security Act (the Act):
• 	Section 1833(e) which states, in part "...no payment shall be made to any
provider... unless there has been furnished such information as may be
necessary in order to determine the amounts due such provider ...;"
• 	Section 1842(a)(2)(B) which requires ACs and MACs to "assist in the
application of safeguards against unnecessary utilization of services furnished
by providers
...; "
• 	Section 1862(a)(1) which states no Medicare payment shall be made for
expenses incurred for items or services that "are not reasonable and necessary
for the diagnosis or treatment of illness or injury or to improve the functioning
of a malformed body member;"
• 	The remainder of Section 1862(a) which describes all statutory exclusions
from coverage;

• 	Section 1893(b)(1) establishes the Medicare Integrity Program which allows
contractors to review activities of providers of services or other individuals and
entities furnishing items and services for which payment may be made under
this title (including skilled nursing facilities and home health agencies),
including medical and utilization review and fraud review (employing similar
standards, processes, and technologies used by private health plans, including
equipment and software technologies which surpass the capability of the
equipment and technologies. . .”
• 	Sections 1812, 1861, and 1832 which describe the Medicare benefit
categories; and
• 	Sections 1874, 1816, and 1842 which provide further authority.
The regulatory authority for the MR program rests in:
• 	42 CFR 421.100 for intermediaries.
• 	42 CFR 421.200 for carriers.
• 	42 CFR 421.400 for MACs.
The UPICs shall refer to chapter 4 for MR for BI purposes.
1.3.8 - Goal of MAC and SMRC MR Program
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
The goal of the MAC and SMRC MR program is to reduce payment error by
preventing the initial payment of claims that do not comply with Medicare’s with
coverage, coding, payment, and billing policies. To achieve the goal of the MR
program,
MACs:
• 	Identify provider noncompliance with coverage, coding, billing, and
payment policies through analysis of data. (e.g., profiling of providers,
services, or beneficiary utilization) and evaluation of other information
(e.g., complaints, enrollment and/or cost report data). (Chapter 2 describes
these activities in further detail.);
• 	Take action to prevent and/or address the identified improper payment; (chapter
3, describes these actions in further detail.); and
• 	Place emphasis on reducing the paid claims error rate by notifying the
individual billing entities (i.e., providers, suppliers, or other approved
clinician) of review findings identified by the ACs or by the MACs and
making appropriate referrals to provider outreach and education (POE), and
UPICs.
SMRC:

• 	Identify provider noncompliance with coverage, coding, billing, and payment
policies through the research and analysis of data related to assigned task.
(e.g., profiling of providers, services, or beneficiary utilization)
• 	As directed by CMS, perform medical review
• 	As directed by CMS, perform extrapolation
• 	Notify the individual billing entities (i.e., providers, suppliers, or other
approved clinician) of review findings identified and make appropriate
recommendations for POE and UPIC referrals
1.3.9 – Provider Self Audits
(Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21)
Providers may conduct self-audits to identify coverage and coding errors. The Office of
Inspector General (OIG) Compliance Program Guidelines can be found at
https://oig.hhs.gov/compliance/compliance-guidance/index.asp and the statistical
guidelines in https://oig.hhs.gov/authorities/docs/selfdisclosure.pdf (if statistical
sampling is utilized during the audit). The MACs shall follow chapter 4, section
4.2.2.8.1.3, handling any voluntary refunds that may result from these provider self-
audits.
Most errors do not represent fraud. Most errors are not acts that were committed
knowingly, willfully, and intentionally. However, in situations where a provider has
repeatedly submitted claims in error, the MACs shall follow the procedures listed in
chapter 3, section 3.2.1. For example, some errors will be the result of provider
misunderstanding or failure to pay adequate attention to Medicare policy. Other errors
will represent calculated plans to knowingly acquire unwarranted payment. Per chapter 4,
section 4.2.1, MACs shall take action commensurate with errors made. The MACs shall
evaluate the circumstances surrounding the errors and proceed with the appropriate plan
of correction.
1.3.10 – Coordination Among Contractors
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
A. Coordination among MACs and UPICs
The MAC MR staff shall coordinate and communicate with their associated UPIC to
ensure coordination of efforts and to prevent inappropriate duplication of review
activities. At any time, suspicion of fraud should result in referral to the UPIC for
development.
B. Coordination among MACs and the Recovery Auditors
See Pub. 100-06, Financial Management Manual, chapter 4, section 100.1-100.15, for
a description of the coordination efforts between MACs and Recovery Auditors. In
addition, the MACs shall coordinate and communicate with the Recovery Auditors to

get the specifics on Recovery Auditor identified vulnerabilities for use in the MAC’s
data analysis and possible corrective actions.
C. SMRC
The SMRC shall make all recommendations for referrals through their CMS
Contract Officer Representative (COR).
1.4 - Contractor Medical Director (CMD)
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
MACs:
The MACs shall employ a minimum of two FTEs contractor medical director (CMD) and
arrange for an alternate when the CMD is unavailable for extended periods. The CMD
FTEs shall be composed of either a Doctor of Medicine or a Doctor of Osteopathy. All
clinicians employed or retained as consultants shall be currently licensed to practice
medicine in the United States, and the contractor shall periodically verify that the license
is current. When recruiting CMDs, contractors shall give preference to physicians who
have patient care experience and are actively involved in the practice of medicine. The
CMD's duties are listed below.
Primary duties include:
• 	Leadership in the provider community, including:
o 	Interacting with medical societies and peer groups;
o 	Educating providers, individually or as a group, regarding identified problems
or LCDs; and
o 	Acting as co-chair of the Contractor Advisory Committee (CAC) (see chapter
13 §13.8.1.4 of this manual for co-chair responsibilities).
• 	Providing the clinical expertise and judgment to develop LCDs and internal MR
guidelines:
o 	Serving as a readily available source of medical information to provide
guidance in questionable claims review situations;
o 	Determining when LCDs are needed or must be revised to address program
abuse;
o 	Assuring that LCDs and associated internal guidelines are appropriate;
o 	Briefing and directing personnel on the correct application of policy during
claim adjudication, including through written internal claim review
guidelines;

o 	Selecting consultants licensed in the pertinent fields of medicine for expert
input into the development of LCDs and internal guidelines;
o 	Keeping abreast of medical practice and technology changes that may result in
improper billing or program abuse;
o 	Providing the clinical expertise and judgment to effectively focus MR on
areas of potential fraud and abuse; and
o 	Serving as a readily available source of medical information to provide
guidance in questionable situations.
Other duties include:
• 	Interacting with the CMDs at other contractors to share information on potential
problem areas;
• 	Participating in CMD clinical workgroups, as appropriate; and
Upon request, providing input to CO on national coverage and payment policy, including
recommendations for relative value unit (RVU) assignments.
SMRC:
Primary duties include:
• 	Serving as a readily available source of medical information to provide guidance
in questionable claims review situations
• 	Providing the clinical expertise and judgment to develop LCDs and internal MR
guidelines
• 	Keeping abreast of medical practice and technology changes that may result in
improper billing or program abuse
• 	Providing clinical expertise and judgment to effectively focus MR on areas of
potential fraud and abuse
• 	Serving as a readily available source of medical information to provide guidance
in questionable situations
1.5 - Medical Review Manager
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
MACs:

An effective MR program begins with the strategies developed and implemented by
senior management staff. The MACs shall name an MR point of contact referred to as the
MR Manager who will act as the primary contact between the contractor and CMS
concerning the contractor's MR program. The MR Manager will also have primary
responsibility for the development, oversight and implementation of the contractor’s MR
Strategy, SAR, and quality assurance process. In addition, the MR Manager shall have
the primary responsibility for ensuring the timely submission of required reports.
SMRC:
An effective Medical Review program begins with the senior management staff. The
Contractor shall name a Medical Review point of contact referred to as the Medical
Review Manager who will act as the primary contact between the Contractor and CMS
concerning the SMRC medical review program. The MR Manager will also have primary
responsibility for development, oversight and implementation of the Contractor’s quality
assurance process. In addition, the MR Manager shall have the primary responsibility for
ensuring the timely submission of required reports. The MR Manager shall be a
registered nurse. The MR Manager shall work collaboratively with their Project Manager
and Contract Medical Director to plan, implement and evaluate all MR projects/tasks
directed by CMS.
1.6 – Maintaining the Confidentiality of MR Medical Records and
Documents
(Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14)
A. Contractors to Which This Section Applies
This section applies to MACs, CERT, Recovery Auditors, and SMRC.
B. General
Contractors shall maintain the confidentiality of all MR medical records and documents
before, during, and after the MR process. Similarly, contractors that use a
subcontractor(s) to perform MR, to store MR documents, and/or to transport MR
documents, are responsible for ensuring that the subcontractor(s) maintains the
confidentiality of the MR documents that it handles. This responsibility applies to all
contact with these documents by all parties and entities, however derived from the
contractor. The responsibility is not limited or ended if the subcontractor allows an
additional party or entity to have contact with these documents. Thus, just as the
contractor shall assure that the subcontractor maintain confidentiality itself, so too shall
the contractor assure that the subcontractor similarly assures that any third party or other
entity, such as a sub to the subcontractor, which has contact with the documents, maintain
confidentiality.
1.7 - Program Integrity
(Rev. 12772; Issued: 08-09-24; Effective: 09-20-24; Implementation: 09-20-24)
A. Contractors to Which This Section Applies

This section applies to UPICs only.
B. General
In addition to reducing improper payments, CMS strives to protect the program
from potential fraud. CMS contracts with Unified Program Integrity Contractors
(UPICs) to identify and stop potential fraud.
The primary task of UPICs is to identify cases of suspected fraud, develop them
thoroughly and in a timely manner, and take immediate action to ensure that Medicare
Trust Fund monies are not inappropriately paid out and that any mistaken payments are
identified. UPICs shall refer cases of potential fraud to the Department of Health and
Human Services (HHS) Office of Inspector General (OIG) Office of Investigations
(OI).
1.8 - Medical Review for Program Integrity (MR for PI)
(Rev. 12772; Issued: 08-09-24; Effective: 09-20-24; Implementation: 09-20-24)
A. Contractors to Which This Section Applies
This section applies to UPICs.
B. General
The goal of the MR for PI is to address situations of potential fraud, waste, and abuse
(e.g., looking for possible falsification).
Information on maintaining the confidentiality of MR documents can be found in
this chapter, section 1.6.

Transmittals Issued for this Chapter
Rev # 	Issue Date 	Subject 	Impl Date CR#
R12772PI 08/09/2024 	Updates of Chapter 1, Chapter 2, Chapter 3,
Chapter 4, and Chapter 9 in Publication (Pub.)
100-08, Including Complaint Referral
Coordination Between Contractors
09/20/2024 13719
R11032PI 09/30/2021 	Updates to Chapters 1, 3, 4, 5, 8 and 9 of
Publication (Pub.) 100-08
11/10/2021 12375
R10984PI 09/09/2021 	Updates to Chapters 1, 3, 4, 5, 8 and 9 of
Publication (Pub.) 100-08 - Rescinded and
replaced by Transmittal 11032
11/10/2021 12375
R10365PI 10/02/2020 	Updates to Chapters 1, 2, 3, 4, 5, 6, 7, 8, 10,
11, and Exhibits of Publication (Pub.) 100-08-
08/27/2020 11884
R10228PI 07/27/2020 	Updates to Chapters 1, 2, 3, 4, 5, 6, 7, 8, 10,
11, and Exhibits of Publication (Pub.) 100-08
Rescinded and Replaced by Transmittal
10365
08/27/2020 11884
R508PI 	03/07/2014 	Supplemental Medical Review Contractor 	04/08/2014 8578
R454PI 	03/14/2013 	Minor Changes to Chapter 1 of the Program
Integrity Manual
04/01/2013 8205
R451PI 	03/01/2013 	Minor Changes to Chapter 1 of the Program
Integrity Manual – Rescinded and replaced by
Transmittal 454
04/01/2013 8205
R448PI 	01/31/2013 	Deletion of MR Operations Mailbox 	03/04/2013 8187
R425PI 	06/15/2012 	Provider Self Audits 	07/16/2012 7851
R313PI 	11/20/2009 	Program Integrity Manual (PIM)
Reorganization Chapters 1, 2, and 7
12/21/2009 6546
R264PI 	08/07/2008 	Transition of Responsibility for Medical
Review From Quality Improvement
Organizations (QIOs)
08/15/2008 5849
R229PI 	11/23/2007 	Medical Review Strategy and Strategy
Analysis Report
04/07/2008 5760
R220PI 	08/24/2007 	Various Medical Review Clarifications 	09/03/2007 5550
R203PI 	05/25/2007 	Strategy Analysis Report 	07/02/2007 5519
R174PI 	11/17/2006 	Transition of Medical Review Educational
Activities
10/06/2006 5275
R170PI 	11/03/2006 	Transition of Medical Review Educational
Activities
10/06/2006 5275
R163PI 	09/29/2006 	Transition of Medical Review Educational
Activities
10/06/2006 5275

R136PI 	02/01/2006 	Contractor Medical Director Requirements 	03/01/2006 4105
R118PI 	08/12/2005 	Various Benefit Integrity (BI) Clarifications 	09/12/2005 3896
R107PI 	04/08/2005 	Updated Chapter 1 to Reflect Changes in
Program Requirements
05/09/2005 3754
R099PI 	01/21/2005 	Waivers Approved by the Regional Office
(RO) by Replacing Regional Office with
Central Office (CO)
02/22/2005 3646
R071PI 	04/09/2004 	Rewrite of Program Integrity Manual (except
Chapter 10) to Apply to PSCs
05/10/2004 3030
R065PI 	01/30/2004 	Requirement Removal of Fiscal Intermediary
Medical Review on Long Term Care
Hospitals
03/02/2004 2905
R040PIM 05/16/2003 	Local Provider Education and Training
Program
05/16/2003 2466
R033PI 	11/01/2002 	FY 2003 Budget Performance Requirement
Revisions
11/01/2002 2407
R025PIM 04/25/2002 	Types of claims for which Contractors are
Responsible
07/01/2002 2122
R024PIM 04/05/2002 	Removes the LMRP and related sections from
Chap 1 and moves to Chap 13
10/01/2002 2061
R021PIM 02/28/2002 	Inpatient Hospital Claims for Which
Contractors are Responsible for Performing
MR
04/01/2002 1969
R019PIM 02/08/2002 	Benefit Integrity Unit Security Requirements 	02/08/2002 1907
R017PIM 12/12/2001 	Reorganizes chapter 3, sections 4, 5, and 6
and Removes reference to outdated MCM and
MIM overpayment collection instructions and
lists the more current CFR citations instead.
04/01/2002 1891
R016PIM 11/28/2001 	Adds Various Program Memoranda for BI
Requests for Information, Organizational
Requirements, Unsolicited Voluntary Refund
Checks, Anti-Kickback Statute Implications
11/28/2001 1732
R014PIM 09/26/2001 	Local Medical Review Policy (LMRP)
Format and Submission/Requirements
10/01/2001 1859
R010PIM 09/17/2001 	Timeframe for Contractor Advisory
Committees (CAC) Meetings
10/17/2001 1744
R009PIM 07/30/2001 	LMRP Process 	NA 	1021
R008PIM 07/11/2001 	Replaces PIM Chapter 1, Sections 2, 2.1, and
sections 2.3 up through and including 2.3.4.
07/11/2001 1485
R006PIM 05/24/2001 	Maintaining the Confidentiality of MR
Records
05/24/2001 1581
R003PIM 11/22/2000 	Complete Replacement of PIM Revision 1. 	NA 	1292

R001PIM 06/2000 	Initial Release of Manual 	NA 	931
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