Medicare Program Integrity Manual (Pub. 100-08), Ch. 11 § 11.1.3.6

MR Program Management Costs (Activity Code 21207)

Last amended: 2020Year: 2020Length: 194 wordsOfficial source
11.1.3.6 – MR Program Management Costs (Activity Code 21207) (Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20) The MR Program Management encompasses managerial responsibilities inherent in managing the MR program, including: development, modification, and periodic reporting of MR strategy and quality assurance activities; planning monitoring and adjusting workload performance; budget-related monitoring and reporting; and implementation of CMS instructions. Activity Code 21207 is designed to capture the costs of managerial oversight for the following tasks: • Develop and periodically modify MR strategy; • Develop and modify quality assurance activities, including special studies, inter- reviewer reliability testing, committee meetings, and periodic reports; • Evaluate edit effectiveness; • Plan, monitor and oversee budget, including interactions with contractor budget staff and RO budget and MR program staff; • Manage workload, including monitoring of monthly workload reports, reallocation of staff resources, and shifts in workload focus when indicated; • Implement MR instructions from regional and/or central office; • Educate staff on MR program, new CMS instructions, and quality assurance findings (this is different from the internal training of MR staff to perform MR activities); and, • Support service for UPIC performing MR activities other than for the CERT contractor.
Medicare Program Integrity Manual (Pub. 100-08), Ch. 11 § 11.1.3.6: MR Program Management Costs (Activity Code 21207) | Justis AI