CMS Pub. 100-06, ch. 1, § 100.10

A1-1213.10, B1-4213.10

The Benefit Integrity function includes the costs and workload(s) associated with

receiving and processing complaints or allegations of Medicare fraud and abuse and

maintenance of associated databases. BI also includes self-initiated data analysis to detect

potential fraud and maintenance of associated databases, and the development of cases

for referral or further action. See work specifically required in §3900.

100.11 - MIP - Provider Education and Training (PET) Function

(Summary Level Code 24000) - (Rev. 1, 08-30-02)

A1-1213.11, B1-4213.11

The MIP - PET function includes the costs for education and training directed at

providers, groups of providers and, in some cases, individual providers depending on the

scope of the problems or need for education to avoid and detect waste, fraud, and abuse.

Costs of PET are allocated to both PM and to MIP.

100.12 - Audit Function (Summary Level Code 26000) - (Rev. 1, 08-30-

02)

A1-1213.12

The Audit function (intermediaries) includes the costs and workload(s) for Provider Desk

Reviews, Audits and Settlements. See §290.

100.13 - MIP Productivity Investments Function (Summary Level Code

27000) - (Rev. 1, 08-30-02)

A1-1213.13, B1-4213.12

The contractor shall use these lines only with specific authorization by CMS for MIP PI.

See the see the Program Integrity Manual for discussion of the PI activities.

100.14 - MIP-Medicare Program Administration (Summary Level Code

29000) - (Rev. 1, 08-30-02)

A1-1213.14, B1-4213.13

The contractor shall use this summary level code only with the concurrence of CMS.

110 - Exhibit of Special Projects Form - (Rev. 1, 08-30-02)

A1-1214, B1-4214

Click here to view Exhibit of Special Projects Form.

110.1 - Completing the Special Projects Form - (Rev. 1, 08-30-02)

1214.1, B1-4214.1

A. General

This schedule is used to identify special project activities. Special projects are defined as

those activities which may be of critical importance from an operational standpoint but

which are not materially significant from a financial standpoint viewed in the context of

the contractor's contract/agreement and its requirements. Therefore, reduced budget and

cost reporting is required. Special projects may relate to any underlying Medicare

function and/or to a specific activity. Because of the non-material (financial) nature of the

activity, the contractor shall charge only direct costs and specifically identifiable and

incremental overhead/G&A costs to the activity.

B. Uses

The schedule will be used only if there are special project activities to report. It will

generally not be used for the BR but may be used for any or all of the following: SBR,

NOBA, IER, and FACP. It shall not be used for cost reporting purposes unless funds are

provided in the NOBA.

C. Explanation of Entries on Special Projects Schedule

1. Code - Special projects are assigned to the 18000 series for PM activities and to the

28000 series for MIP activities. See §90.4 for a further discussion of activity codes.

2. Description - Brief description of the activity.

3. Productive Hours -The contractor shall include all productive hours. (See §90.9P.)

4. Salaries/Fringe Benefits - The contractor shall include all salaries, wages and fringe

benefits. (See §90.9 A-B.)

5. Subcontracts - The contractor shall include all subcontract costs. (See §90.9D.)

6. Other Costs - The contractor shall include all costs and, if applicable, non-COB

credits not included in personal service costs and subcontracts. This may include: EDP

equipment, other direct costs, other costs, non-COB credits and incremental

overhead/G&A. It should not confuse this cost category with the "other costs" reported

on the Activity Screen. See §§90.9C and 90.9E-I. It shall also include any adjustments or

forward funding when appropriate on the FACP. (See §90.9L-M.)

7. Total Cost - The sum of salaries/fringe benefits, subcontract and all other costs above.

Note that special project activity costs are NOT included in any other activity and must

be separately reported on this schedule and that total costs should equate to total costs as

defined in §90.9K and not to Total Adjusted Cost as defined in §90.9N.

8. Workload - The contractor shall report the related workload if appropriate.

120 - Exhibit of Schedule of Other Direct Costs (Schedule A) - (Rev. 1,

08-30-02)

A1-1215, B1-4215

Click here to view Exhibit of Schedule of Other Direct Costs (Schedule A)