FM1
CMS-Required Outcome
CMS-required outcome
The system calculates FFS provider payment or recoupment amounts, as well as value-based and alternative payment models (APM), correctly and initiates payment or recoupment action as appropriate.
Default metrics
- Count/percentage and amount/percentage of corrected claims by program, service category, and payment model. Report Medicaid and CHIP metrics separately.
Regulatory sources
- Section 1902(a)(37) of the Act
- 42 CFR 433.139
- 42 CFR 447.20
- 42 CFR 447.45
- 42 CFR 447.56
- 42 CFR 447.272