FMFIA and the CMS Medicare Contractor Contract

10.1.2 - FMFIA and the CMS Medicare Contractor Contract (Rev. 331, Issued: 11-15-19, Effective: 10-01-19, Implementation: 12-17- 19) The CMS contract with its Medicare Title XVIII contractors includes an article titled FMFIA. In this article, the contractor agrees to cooperate with CMS in the development of procedures permitting CMS to comply with FMFIA and other related standards prescribed by the Comptroller General of the United States. The Medicare Part A and Part B (A/B) Medicare Administrative Contractor (MAC), Durable Medical Equipment (DME) MAC, and Specialty MAC (SMAC) (A/B, DME, & Specialty MACs) Statements of Work (SOW) states that, “the contractor shall establish and maintain efficient and effective internal controls to perform the requirements of the contract in accordance with IOM Pub. 100-06, Chapter 7”. Under various provisions of the Social Security Act, and the Medicare Prescription Drug, Improvement Modernization Act of 2003 (MMA), contractors shall be evaluated by CMS on administrative service performance. The CMS evaluates contractor’s performance by various internal and external reviews. To further sensitize the contractors as to the importance of FMFIA compliance, CMS requires the contractors to annually provide assurance that internal controls are in place and to identify and correct any areas of weakness in their operations. The vehicle used by the contractors to provide this assurance is the Certification Package for Internal Controls (CPIC). The CPIC includes a self-certification representation that the contractor’s internal controls are in compliance with FMFIA expectations, that the contractor recognizes the importance of internal controls, and the contractor has provided required documentation in the package. End Section 10.1.2 – FMFIA and the CMS Medicare Contractor Contract: Back to Table of Contents