CMS Pub. 100-08, ch. 7, § 7.3.2.3

The SAR requires the MAC to assess their prioritized IPRS problem list and report on

that assessment to date. The SAR shall summarize the MR activities, improper payment

interventions, and MR activities taken to address each of the identified prioritized

problems in the MAC’s IPRS.

This section shall include details on both prioritized problems that were contained in the

IPRS, in addition to newly identified problems. Units or measurements used to quantify

baseline problem measurements, improvement goals, and the achievement or non-achievement of the improvement goals shall be consistent throughout the SAR and IPRS.

For each specific prioritized problem on the IPRS problem list, the MAC shall provide

the following information:

A. Prioritized problem description.

Each prioritized problem on the problem list shall include a problem description. This

section shall contain a brief description of problem characteristics and associated planned

MR activities and improper payment interventions. The MAC shall include information

regarding how the problem was identified (i.e., CERT, Recovery Auditor, CMS, OIG,

Comparative Billing Report (CBR), MAC internal data analysis, GAO, etc.)

Duplication of the details contained in the IPRS is not needed; rather, the MAC may refer

the reader to the previous IPRS for detailed descriptions, as required. The reader should

easily see that the problems already identified and defined in the IPRS correspond to the

SAR’s listing of numbered problems.

The MAC shall also provide the problem identification number or case number (if used)

that is not the ranking number of the prioritized problem. This number shall be consistent

in the IPRS and the SAR.

B. Whether the prioritized problem is a new or carry-over problem from the IPRS.

The MAC shall report on both the problems that were identified in the IPRS as well as

problems that have been added to the IPRS prioritized list as a result of data analysis.

Any prioritized problem removed since the last IPRS shall be explained.

For problems that have been newly identified and added to the SAR subsequent to the

IPRS submission, a detailed narrative is appropriate.