Background

7.2.1 - Background (Rev. 444, Issued: 12-14-12, Effective: 04- 01- 13 (FISS and MCS); 07-01-13 (VMS); Implementation: April 1, 2013 (Implementation of FISS and MCS); July 1, 2013 (Implementation of VMS) This section provides requirements and instructions for Part A, Part B, and Durable Medical Equipment (DME) MACs, fiscal intermediaries (FIs), and carriers. The reporting requirements for Medical Review (MR) activities performed by the Contractor were formerly captured in the Program Integrity Management Reporting (PIMR) system. Effective 7/1/2012, the PIMR system was retired, requiring the revision to this chapter of the Program Integrity Manual. The new process for the oversight of Medical Review activities administered by the Contractor will improve the management of medical review cost, savings, and workload. The manual Medical Review Savings reporting process will replace the Program Integrity Manual Review system. The Medical Review, savings, and workload data shall be collected through the use of a manual report until such a time that it is decided that an automated reporting system is required and developed to meet the business needs of The CMS Office of Financial Management, Provider Compliance Group, Division of Medical Review and Education. The CMS will obtain Medical Review Savings data through manual reporting by Contractor staff. Those reports will be due monthly, on the20th day of the month.