ACTUARIAL RESEARCH CORPORATION - PROVIDE CMS WITH ACTUARIAL, RATE-REVIEW, AND ANALYTIC SERVICES TO SUPPORT THE ONGOING OPERATIONS OF MEDICARE-MEDICAID FINANCIAL ALIGNMENT MODEL DEMONSTRATIONS FOR INDIVIDUALS ENROLLED IN BOTH MEDICARE AND MEDICAID (DUALLY ELIGIBLE BENEFICIARIES). THE

IGF::OT::IGF-PPHF-2013-ELIGIBILITY SUPPORT

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IGF::OT::IGF FOR OTHER FUNCTIONS

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IGF::OT::IGF CCIIO ENROLLMENT RESOLUTION AND RECONCILIATION, FORM 1095-A DATA REPORTING TASK ORDER

COGNOSANTE, LLC

IGF::OT::IGF ELIGIBILITY APPEALS OPERATIONS SUPPORT

MAXIMUS FEDERAL SERVICES, INC.

IGF::OT::IGF THE CERT PROGRAM CALCULATES BI-ANNUAL IMPROPER PAYMENT RATES BASED ON THE RESULTS OF THE REVIEWS CONDUCTED. THESE RATES INCLUDE AN OVERALL NATIONAL MEDICARE FFS IMPROPER PAYMENT RATE AND IMPROPER PAYMENT RATES FOR EACH CLAIM TYPE [PART A INPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM (PPS); PART A EXCLUDING INPATIENT HOSPITAL PPS; PART B; AND DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES (DMEPOS)]. THE CERT PROGRAM ENSURES A STATISTICALLY VALID RANDOM SAMPLE; THEREFORE, THE IMPROPER PAYMENT RATE CALCULATED FROM THIS SAMPLE IS CONSIDERED TO BE REFLECTIVE OF ALL OF CLAIMS PROCESSED BY MEDICARE FFS PROGRAM DURING THE REPORT PERIOD. CMS ALSO USES THE CERT PROGRAM TO PERFORM SPECIAL STUDIES AND SUPPLEMENTAL MEASUREMENTS TO DETERMINE THE IMPROPER PAYMENT RATES OF PARTICULAR CLAIM TYPES. CALCULATIONS OF THESE RATES FACILITATE CMS ABILITY TO TAKE APPROPRIATE CORRECTIVE ACTIONS TO REDUCE IMPROPER PAYMENTS.

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