100-08 Medicare Program Integrity Manual: Chapter 11 - Fiscal Administration

Medicare Program Integrity Manual
Chapter 11 - Fiscal Administration
Table of Contents
(Rev. 10365, 10-02-20)
Transmittals for Chapter 11
11.1 - Medical Review (MR)
11.1.1 - MR Overview
11.1.2 - Reporting MR Workload and Cost Information and Documentation in
CAFM
11.1.3 – CAFM II Reporting for MR Activities
11.1.3.1 - Automated Review Workload and Cost (Activity Code 21001)
11.1.3.2 - Routine Review Workload and Cost (Activity Code 21002)
11.1.3.3 - Data Analysis Cost (Activity Code 21007)
11.1.3.4 - Third Party Liability or Demand Bills Workload and Cost
(Activity Code 21010)
11.1.3.5 – Policy Reconsideration/Revision Activities (Activity Code
21206)
11.1.3.6 – MR Program Management Costs (Activity Code 21207)
11.1.3.7 – New Policy Development Activities (Activity Code 21208)
11.1.3.8 – Complex Probe Review Workload and Costs (Activity Code
21220)
11.1.3.9 – Prepay Complex Review Workload and Cost (Activity Code
21221)
11.1.3.10 - Postpay Complex Review Workload and Cost (Activity Code
21222)
11.1.3.11 – Postpay Complex Review Workload and Cost (Activity Code
21222)
11.1.4 - MIP Comprehensive Error Rate Testing (CERT) Support
11.1.4.1 – MIP CERT Support (Activity Code 21901)
11.1.5 - Reporting Internal Staff Training
11.1.6 - Reporting MR Savings in CROWD
11.2 - LPET Overview
11.2.1 - Reporting LPET Workload and Cost Information and Documentation in
CAFM II
11.2.2.1 – One-on-One Provider Education Workload and Cost (Activity
Code 24116)

11.2.2.2 – Education Delivered to a Group of Providers Workload and
Cost (Activity Code 24117)
11.2.2.3 – Education Delivered via Electronic or Paper Media Workload
and Cost (Activity Code 24118)

11.1 - Medical Review (MR)
(Rev. 174, Issued: 11-17-06; Effective: 10-01-2006; Implementation: 10-02-06)
Contractors are required to incorporate Activity Based Costing (ABC) in the budget
process. ABC is a management reporting system that allows contractors to focus on the
costs of the work activities instead of the standard cost centers associated with the
traditional cost accounting structure. ABC identifies an all inclusive business process for
each activity so that the total costs of the activity are fully visible to the MR business
manager. Refer to Medicare Financial Management Manual,
www.cms.gov/manuals/106_financial/fin106index.asp chapters 1, 2, 5, and 6 for more
detailed explanation of ABC.
11.1.1 – MR Overview
(Rev. 174, Issued: 11-17-06; Effective: 10-01-2006; Implementation: 10-02-06)
This chapter of the PIM lists the requirements contractors must follow when allocating
MR Costs, Savings and Workload to the MR activities in CAFM and CROWD. These
requirements formerly appeared in MCM, Part 1, 4213; MIM, Part 1, 1213 and the MR
Budget and Performance Requirements (BPRs). Contractors must allocate to the MR
activity code in CAFM II only the workload and costs associated with MR tasks.
Contractors must allocate to the MR line in CROWD only these savings that are
generated by MR tasks. For example:
• 	If a nurse reviewer spends 90% of her time performing prepay complex medical
review and 10% of her time performing appeals review at the request of the appeals unit,
the contractor must allocate 90% of this nurse's salary/fringes to 21221 and the 10% to
the appropriate appeals activity code.
• 	If a non-clinician medical reviewer spends 80% of his time performing Routine
review and 20% of his time performing suspect duplicate reviews, the contractor must
allocate 80% of this reviewer's salary/fringes to 21002 and the 20% to the appropriate
claims processing activity code.
• 	If a nurse reviewer spends 70% of her time performing postpay complex review
for the purpose of making a coverage determination on a provider who has been selected
for targeted PCA review and 30% of her time performing reviews to support the claims
processing unit, the contractor should report 70% to Postpay Complex Review 21222 and
30% to the appropriate claims processing activity code.
Refer to chapter 1, section 2 www.cms.gov/manuals/108_pim/pim83c01.asp#Sect2 of
this manual for detailed overview of the MR Program. This chapter lists the requirements
contractors must follow when allocating MR costs and workload to the MR activities in
CAFM II. Contractors will be given a specified maximum budget for MR. Based on this
budget the contractor is asked to develop a unique MR strategy within their jurisdiction
that is consistent with the goal of reducing the error rate. The contractor shall utilize their

targeted budget in its entirety on MR activities toward the prevention of waste and abuse
to the Medicare program.
11.1.2 –Reporting MR Workload and Cost Information and
Documentation in CAFM II
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
Workload information and associated workload cost information shall be maintained and
documented on-site by all MR contractors. Each site shall maintain records of its own
workload information and associated workload cost information. Contractors shall be
able to provide this information upon request from RO and/or CO. Site-specific
workload and cost information shall be reported in the remarks section of CAFM II. With
RO consent, this information may be submitted by other means with an indication made
in the remarks section of the CAFM II IER report.
The MR strategy shall include a section that describes the process used to monitor
spending in each activity code. The process shall ensure that spending is consistent with
the allocated budget and includes a process to revise the plan when spending is over or
under the budget allocation. In addition, the strategy shall describe how workload for
each activity code is accurately and consistently reported. The workload reporting
process shall also assure proper allocation of employee hours required for each activity.
Contractor’s MR workload records shall include workload information captured by the
Interim Expenditure Report (IER). Only costs (direct, indirect, overhead) incurred to
support MR activities are reported on the MR line. Contractors are responsible for
ensuring the accuracy of the information contained in CAFM II. The contractor shall alert
the RO (for UPICs, the GTL, Associate GTL, and SME) to any software or hardware
problems that hinder the contractor’s ability to report accurate data in CAFM II. The
contractor should cc MROperations@CMS.HHS.gov.
11.1.3 – CAFM II Reporting for MR Activities
(Rev. 174, Issued: 11-17-06; Effective: 10-01-2006; Implementation: 10-02-06)
Contractors shall report all costs associated with the medical review of claims, e.g.,
sampling design and execution; claims examination, reviewing medical records and
associated documentation; assessing overpayments; and contacting providers to notify
them of overpayment assessment decisions. All costs associated with collecting the
overpayment shall be allocated to the appropriate overpayment collection CAFM II
activity code.
To be counted as medical review workload, all claims reviewed by medical review shall
be identified in the MR strategy and be the result of a MR edit. If resources allow, a MR
clinician may be shared with another functional area, such as provider outreach and
education, claims processing or appeals, as long as only the percentage of the clinician’s
time spent on MR activities is identified in the strategy and accounted for in the
appropriate functional budget area.

The review of a claim for MR purposes is only counted as medically reviewed once no
matter how many times the same claim is reviewed during claims processing. MCS users
will be exempt from this requirement until July 5, 2005. Effective July 5, 2005 the MCS
system shall be revised to automatically deny duplicates of denied lines. Duplicates of
denied lines are defined as newly submitted lines that duplicate a line that a contractor
has (a) already denied, (b) medically reviewed, or (c) for which the contractor requested
but did not received documentation. Denial of duplicate lines shall not be appealable
unless the provider documents that the service was not a duplicate because it was
performed more often than indicated in the original line. Use a “Duplicate non-paid”
denial message whenever this denial is made.
11.1.3.1 - Automated Review Workload and Cost (Activity Code 21001)
(Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04)
Contractors shall report the costs associated with automated review including personnel
to install and activate supplemental edit software in Activity Code 21001. In the
workload section of the CAFM II, Activity Code 21001, contractors shall report the
number of claims denied in whole or in part in Workload 1. To the extent the contractor
can report claims subjected to automated medical review, this number should be reported
in Workload 2. (IOM Pub 100-08, ch.3, §3.4.5.)
11.1.3.2 - Routine Review Workload and Cost (Activity Code 21002)
(Rev. 130, Issued: 11-10-05, Effective: 10-01-05, Implementation: 12-12-05)
Contractors shall report all costs associated with routine reviews in Activity Code 21002.
Costs associated with collecting an overpayment shall not be reported to this activity
code. In the workload section of CAFMII, Activity Code 21002, report the number of
claims reviewed in Workload 1. Contractors shall report number of claims denied in
whole or in part in Workload 2. Include those post payment claims where no
documentation was received in workload 2. Report the number of providers subject to
routine review in Workload 3. (IOM Pub 100-08, ch.3 §3.4.5.)
11.1.3.3 - Data Analysis Cost (Activity Code 21007)
(Rev. 174, Issued: 11-17-06; Effective: 10-01-2006; Implementation: 10-02-06)
Contractors shall report costs associated with data analysis activities associated with
discovering program vulnerabilities and developing a MR prioritized problem list (IOM
Pub 100-8, ch. 1) in CAFM II Activity Code 21007. However, analysis of the data to
develop and deliver educational interventions shall not be reported in an MR activity
code. In addition, data analysis associated with benefit integrity and law enforcement
support shall not be reported here. There is no claims workload to be reported for this
activity.

11.1.3.4 - Third Party Liability or Demand Bills Workload and Cost
(Activity Code 21010)
(Rev. 185, Issued: 01-26-07, Effective: 02-26-07, Implementation: 02-26-07)
Intermediaries shall report only the workload and costs associated with the medical
review of third party liability claims and the workload and costs associated with the
medical review of demand bills. Funding for claims processing and the appeals for third
party liability and demand bills must be funded through program management.
Intermediaries shall report the costs associated with the medical review of third party
liability claims and the medical review of demand bills in Activity Code 21010.
Intermediaries shall report the total number of claims reviewed, i.e., third party liability
claims plus claims for demand bills, in Workload 1 in CAFM II Activity Code 21010.
Intermediaries shall report the number of claims denied in whole or in part in Workload
2. Intermediaries shall report demand bills (claims) reviewed in Workload 3.
An exception to the preceding instruction may occur when the provider submits a home
health demand bill (condition code 20) type 32X, 33X, or 34X, and the beneficiary has
not selected the checkbox indicating that he or she wants Medicare to be billed on the
Home Health Advance Beneficiary Notice (HHABN). In most cases, the contractor shall
return to the provider (RTP) such claims submitted in error, except in the case of dual-
eligible beneficiaries where there is a state-specific policy regarding billing Medicare.
Contractors and HHAs who serve dual-eligibles shall comply with a state-specific policy
on billing for dual-eligible beneficiaries (see CMS Pub. IOM 100-04, chapter 60, §60.5
A. for further instruction on that situation).
11.1.3.5 - Policy Reconsideration/Revision Activities (Activity Code
21206)
(Rev. 130, Issued: 11-10-05, Effective: 10-01-05, Implementation: 12-12-05)
In an attempt to achieve jurisdictional consistency, multi-state contractors shall develop
and revise local policies that apply to all their states. When reporting workload to CAFM
II, the contractor shall report just one LCD, even if that policy varies slightly from state
to state.
Report all costs associated with reconsiderations and revisions to LCD in CAFM II
Activity Code 21206. Include reconsideration requests made as a result of IOM Pub.100-
08 ch.13 §13.10. The cost of inputting the LCD into the Fu database shall also be
reported here and not in activity code 24118 – Education delivered through electronic or
paper media. Report the total number of policies revised or retired in the month it became
effective in Workload 1. Report the number of policies revised that required notice or
comment as Workload 2. Report the number of policies revised due to an outside request
(e.g., beneficiary or provider request) in Workload 3.

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.
11.1.3.7 - New Policy Development Activities (Activity Code 21208)
(Rev. 130, Issued: 11-10-05, Effective: 10-01-05, Implementation: 12-12-05)
In an attempt to achieve jurisdictional consistency, multi-state contractors shall develop
and revise local policies that apply to all their states. When reporting workload to CAFM
II, the contractor shall report just one LCD, even if that policy varies slightly from state
to state.
Report all costs associated with new LCD development activity in CAFM II Activity
Code 21208. Include in this cost inputting the LCD into the Fu database, do not report
this cost in activity code 24118 – Education delivered through paper or electronic media.

Report the number of new policies that were presented for comment as Workload 1.
Report the number of new policies that were released for notice in the month that it
became effective in Workload 2. Report the number of Investigational Device Exemption
(IDE) requests reviewed in Workload 3.
11.1.3.8 - Complex Probe Review Workload and Costs (Activity Code
21220)
(Rev. 130, Issued: 11-10-05, Effective: 10-01-05, Implementation: 12-12-05)
Report all costs associated with complex probe review in Activity Code 21220. In the
workload section of CAFM II, Activity Code 21220, report the number of claims
reviewed in Workload 1. Report the number of claims denied in whole or in part in
Workload 2. Report the number of providers subject to complex probe review in
Workload 3.
11.1.3.9 - Prepay Complex Review Workload and Cost (Activity Code
21221)
(Rev. 171; Issued: 11-09-06; Effective: 01-01-07; Implementation: 12-09-06)
Report all costs associated with prepay complex review in Activity Code 21221. In the
workload section of CAFM II, Activity Code 21221, report the number of claims
reviewed in Workload 1. Report the number of claims denied in whole or in part in
Workload 2. Report the number of providers subject to prepay complex review in
Workload 3.
The DMERCs shall report the number of Advanced Determinations of Medicare
Coverage accepted (CMS IOM Pub.100-8, chapter.5, section 5.7) to miscellaneous code
21221/01.
The carriers and fiscal intermediaries shall report the therapy cap workload in activity
code 27021.
11.1.3.10 - Postpay Complex Review Workload and Cost (Activity Code
21222)
(Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04)
Contractors shall report all costs associated with Postpay Complex Review in Activity
Code 21222. In the workload section of Activity Code 21222, contractors shall report the
total number of claims reviewed on a postpayment basis as Workload 1 and report the
total number of claims denied in whole or in part as Workload 2. Report the number of
providers subject to postpay complex review in Workload 3. (IOM Pub 100-08, ch. 3.
§4.5.)
11.1.3.11 – Postpay Complex Review Workload and Cost (Activity Code
21222)

(Rev.)
11.1.4 - MIP Comprehensive Error Rate Testing (CERT) Support
(Rev. 174, Issued: 11-17-06; Effective: 10-01-2006; Implementation: 10-02-06)
Beginning in FY 2005, CMS will provide funding earmarked for the AC to support the
CERT contractor. This funding will be a “reverse auction” funding system as is found in
the MR program. The CERT Support funding is over-and-above the level of funding
provided to perform the MR activities listed above. Contractors are not required to
develop a MIP CERT Support strategy. Contractors shall not include MIP CERT
Support work in their MR strategies. Contractors shall not shift additional funds from MR
activities to this line.
In addition to satisfying all requirements contained here, contractors shall carry out all
CERT Support activities identified in IOM Pub.100-8, chapter 12, and all relevant MIP
CERT Support One Time Notifications.
11.1.4.1 - MIP CERT Support (Activity Code 21901)
(Rev. 220, Issued: 08-24-07, Effective: 09-03-07, Implementation: 09-03-07)
Report the costs associated with time spent on MIP CERT Support Activities. These
activities include but are not limited to the following:
o 	Providing review information to the CERT contractor as described in IOM Pub.
100-08, ch.12 § 3.3.2.
o 	Providing feedback information to the CERT contractor as described in IOM Pub.
100-08, ch.12, § 3.3.3 including but not limited to:
+ 	CMD discussions about CERT findings;
+ 	Participation in biweekly CERT conference calls;
+ 	Responding to inquiries from the CERT contractor; and
+ 	Preparing dispute cases.
o 	Preparing the Error Rate Reduction Plan (ERRP) as described in IOM Pub..100-
08, ch. 12, §3.9 (Do not include costs of developing MR Strategy or the Quarterly
Strategy Analysis (QSA). The cost of developing the MR Strategy and QSA shall be
captured in MR CAFM code 21207).
o 	Educating the provider community about CERT as described in IOM Pub. 100-
08, ch.12, § 3.8.
o 	Contacting non-responders and referring recalcitrant non-responders to the OIG
as described in IOM Pub. 100-08, ch.12, § 3.10.

Contractors shall NOT report costs associated with the following activities in this activity
code:
• 	Providing sample information to the CERT Contractor as described
in IOM Pub. 100-08, ch. 12, §3.3.1A&B (these costs should be allocated to the PM
CERT Support Code – 12901 -- described in the Appeals BPR);
• 	Ensuring that the correct provider address is supplied to the CERT
Contractor as described in IOM Pub. 100-08, ch. 12, §3.3.1.C (these costs should be
allocated to the PM CERT Support Code – 12901 -- described in the Appeals BPR);
Researching ‘no resolution’ cases as described in IOM Pub. 100-08, ch. 12, §3.3.1.B
(these costs should be allocated to the PM CERT Support Code – 12901 -- described in
the Appeals BPR).
11.1.5 – Reporting Internal Staff Training
(Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04)
For all internal staff training, charge the portion of the salaries for individuals attending
the training to the activity(s) that the individual performs.
For training related to a particular MR activity(s) allocate the cost for the training and any
associated travel cost to the activity(s) that the training benefits in other direct costs.
For training that benefits the overall MR program – if an individual attends the training -
charge the costs of the training and any associated travel costs to the activity(s) that the
individual performs in other direct costs. If a group attends the training, distribute the
costs of the training and any associated travel costs among all MR activity codes in other
direct costs.
For training that is required by CMS or benefits the Medicare program, allocate training
and travel costs to overhead.
11.1.6 - Reporting MR Savings in CROWD
(Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04)
Contractors shall report in CROWD only those actual savings that are generated from
MR claims review.
Include as MR savings the following:
• 	Actual savings that result from all coverage and coding reviews done for MR
purposes. Include all benefit category, statutory exclusion and, reasonable and necessary
reviews done for MR purposes.
Contractors shall not include as MR savings:

• 	Avoided costs (e.g. a reduction in the number of claims submitted, compared to
historical patterns, attributed to a new or revised LCD) shall not be considered "savings."
• 	Savings that result from coverage or coding reviews performed at the request of
the fraud unit.
• 	Savings that result from any review other than coverage or coding.
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.
11.2.1 - Reporting LPET Workload and Cost Information and
Documentation in CAFM II
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
Workload information and associated workload cost information shall be maintained and
documented on site by all contractors. Each site shall maintain records of its own
workload information and associated workload cost information. Contractors shall be
able to provide this information upon request from RO and/or CO. Site-specific workload
and cost information should be reported in the remarks section of CAFM II. With RO
consent, this information may be submitted by other means with an indication made in
the remarks section of the CAFM II IER report.
The contractors' LPET workload records shall include workload information captured by
the Interim Expenditure Report (IER). Only costs (direct, indirect, overhead) incurred in
LPET activities are reported in CAFM II activity codes. Analysis of the data to develop
and deliver LPET interventions shall be reported in an associated LPET activity code.
Contractors are responsible for ensuring the accuracy of the information contained in
CAFM II. The contractor shall alert the RO (for UPICs, the GTL, Co-GTL, and
SME) to any software or hardware problems that hinder the contractor's ability to
report accurate data on CAFM II.
Since LPET is related to medical review activities, Joint Operating Agreements between
Unified Program Integrity Contractors (UPIC) and Affiliated Contractors (AC) should
reflect proportionate allocation of tasks delineated to MR and LPET. When negotiating
Joint Operating Agreements, the UPICs should be cognizant of their task order.
11.2.2.1 – One-on-One Provider Education Workload and Cost (Activity
Code 24116)
(Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04)
Report the costs associated with One-on-One Provider Education in Activity Code 24116.
Written materials, or electronic communications to providers during a One-on-One
Provider Education, shall not be reported in Education Delivered via Electronic or Paper
Media, Activity Code 24118, but included in the cost for One-on-One education. Activity
Code 24116 - One-on-One Provider Education shall capture the one-on-one contact
between the contractor and provider, and the written materials or electronic
communication used to facilitate the one-on-one education. Included in this activity code
would be letters sent to a provider that specifically addresses the medical review findings
and instructions to correct the errors. Any provider contact made solely by paper or
computer, without specifically addressing an individual provider, should not be reported
here. (IOM Pub. 100-08, chapter 1.)

For One-on-One Provider Education, Activity Code 24116, report the number of
educational contacts in Workload 1. Report the number of providers educated in
Workload 2. If a provider sends a representative(s) on his behalf to a one-on-one
educational contact, count the number of provider(s), not representative(s), to whom the
educational activity was directed.
11.2.2.2 – Education Delivered to a Group of Providers Workload and
Cost (Activity Code 24117)
(Rev. 130, Issued: 11-10-05, Effective: 10-01-05, Implementation: 12-12-05)
Report the costs associated with Education Delivered to a Group of Providers in Activity
Code 24117. Report the number of group educational activities in Workload 1. Report
the number of providers educated in Workload 2. If a provider sends a representative(s)
on his behalf to a group education activity, count the number of provider(s), not
representative(s), to whom the educational activity was directed. (IOM Pub. 100-08,
ch.1.)
11.2.2.3 – Education Delivered via Electronic or Paper Media Workload
and Cost (Activity Code 24118)
(Rev. 89, Issued: 11-26-04, Effective: 12-27-04, Implementation: 12-27-04)
Report the costs associated with Education Delivered via Electronic or Paper Media in
Activity Code 24118. Report the total number of educational documents developed for
use in non-interactive educational interventions in Workload 1. Report the number of
CBRs developed in Workload 2 (do not include CBRs developed for Activities in 24116
and 24117). Report the number of articles/advisories/bulletins developed in Workload
3.Workloads 2 and 3 are subsets to workload 1. If an educational bulletin is published in
a number of different venues, count that bulletin only once, even if publication occurs in
different months.

Transmittals Issued for this Chapter
Rev # 	Issue Date 	Subject 	Impl Date CR#
R10365PI 10/02/2020 	Updates to Chapters 1, 2, 3, 4, 5, 6, 7, 8, 10,
11, and Exhibits of Publication (Pub.) 100-08
08/27/2020 11884
R10228PI 07/27/2020 	Updates to Chapters 1, 2, 3, 4, 5, 6, 7, 8, 10,
11, and Exhibits of Publication (Pub.) 100-08
Replaced by Transmittal 10365
08/27/2020 11884
R220PI 	08/24/2007 	Various Medical Review Clarifications 	09/03/2007 5550
R185PI 	01/26/2007 	Updating Financial Reporting Requirements
for Workload and Cost Associated With the
Return of Demand Bills
02/26/2007 4378
R174PI 	11/17/2006 	Transition of Medical Review Educational
Activities
10/06/2006 5275
R171PI 	11/09/2006 	Outpatient Therapy Cap Clarifications 	12/09/2006 5271
R170PI 	11/03/2006 	Transition of Medical Review Educational
Activities - Replaced by Transmittal 174
10/06/2006 5275
R163PI 	09/29/2006 	Transition of Medical Review Educational
Activities - Replaced by Transmittal 170
10/06/2006 5275
R146PI 	04/28/2006 	Provider Enrollment Update 	05/30/2006 4340
R140PI 	02/15/2006 	Therapy Caps Exception Process 	03/13/2006 4364
R139PI 	02/13/2006 	Therapy Caps Exception Process - Replaced
by Transmittal 140
03/13/2006 4364
R130PI 	11/10/2005 	Correction/Clarification of Several Sections 	12/12/2005 4020
R104PI 	02/11/2005 	Requirement that Medicare Carrier System
(MCS) Not Allow the Re-review of
Previously Denied Claims
07/05/2005 3622
R089PI 	11/26/2004 	Updating Financial Reporting Requirements
for Medical Review and Local Provider
Education and Training
12/27/2004 3446
R071PI 	04/09/2004 	Rewrite of Program Integrity Manual (except
Chapter 10) to Apply to PSCs
05/10/2004 3030
R36PI 	12/27/2002 	New sections added to Chapter 	12/27/2002 2419
R033PI 	11/01/2002 	Fiscal Administration 	11/01/2002 2407
R022PIM 05/05/2002 	Clarification & Manualization of Chapter 	04/01/2002 1962
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