Medicare Program Integrity Manual (Pub. 100-08), Ch. 11 § 11.2

LPET Overview

Last amended: 2004Year: 2004Length: 472 wordsOfficial source
11.2 - LPET Overview (Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04) Contractors shall consider various elements when planning their LPET budget. For example, contractors shall explain how they plan to allocate provider educational activities between LPET and PCOM. The LPET subjects include medical review findings, and education on LCDs as identified through the PCA process. PCOM subjects include issues of national scope or impact. While there are fundamental differences between the LPET and PCOM programs, there may be circumstances when it would be feasible to provide educational events that encompass the scope of both of these programs. For any function such as seminars, conventions, or conferences that address LPET as well as PCOM subjects, the proportional share of the cost of that function to be allocated to LPET, is equal to the percentage of time related to addressing LPET subject matter, multiplied by the cost of the function. For example, the proportional share of the cost of a seminar to be allocated to LPET, is equal to the percentage of the seminar related to addressing LPET subjects, multiplied by the cost of the seminar (e.g., if it costs $4,000 to arrange and conduct a seminar containing 75 percent MR and 25 percent national coverage information, then the LPET cost would be $4,000 multiplied by 0.75 or $3,000 and the remaining $1,000 would be charged to PCOM). However, if the intent of the educational intervention is purely LPET, but PCOM issues arise; address the issues to the extent possible, but charge the cost of the intervention to LPET. This methodology for allocating costs also applies to other general, all-purpose provider education tools or materials, such as regularly scheduled bulletins/newsletters. The costs for developing, producing, and distributing bulletins, should be allocated proportionally according to the percentage of the time spent on each subject in the bulletin between LPET and PCOM. Each contractor will be given a specified maximum budget for LPET activities. Contractors shall identify the appropriate budget and workload for each activity code within the constraints of their budgets. Contractors are not permitted to charge providers/suppliers for planned educational activities and training materials. However, contractors may assess fees of no more than the cost for educational activities delivered at a non-Medicare contractor sponsored event, or when specifically requested by specialty societies or associations. In addition, although contractors are mandated to supply providers with a paper copy of their bulletin at no cost, contractors may assess a fee to cover costs if the provider requests additional copies. All monies collected must be reported as a credit in the applicable activity code and accompanied with a rationale for charging the fee. The fees must be fair and reasonable. Revenues collected from discretionary activities must be used only to cover the cost of these activities and may not be used to supplement other contractor activities.
Medicare Program Integrity Manual (Pub. 100-08), Ch. 11 § 11.2: LPET Overview | Justis AI